The TYP held its seventh Public Conversation at 6pm on Wednesday, November 17, 2010 at New Harvest Park. The topic was “KCDC, Affordable Housing, and the Homeless.” Mary Thom Adams acted as moderator. Deborah Taylor, KCDC’s Section 8 Director, delivered a presentation about KCDC and the Section 8 program. Alvin Nance, Executive Director of KCDC, and Billie Spicuzza, Senior Vice President of Housing for KCDC were present and answered questions and offered input.  The meeting was attended by approximately 35 people and the conversation, once again, was respectful and extremely informative.

Notes

[These are my notes. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post. Please tell us who you are and where you live.]

Attendees included several City Councilpersons: Duane Grieve, Daniel Brown, Nick Della Volpe, and former Councilman Barbara Pelot. Knox County Commissioner Amy Broyles and former Commissioner Mark Harmon were present. My apologies if I’ve missed anyone. The format of this meeting was one hour. The first quarter hour, approximately, was used for presentation. The remainder was for conversation with attendees.

Ms. Adams, in her role as moderator, introduced Ms. Taylor and focused this meeting’s topic on KCDC, Section 8 and affordable housing. Ms. Adams said that she participates in these public conversations because she has a home, is thankful and blessed to have it, and has the good fortune to be able to work with people who need help to gain access to homes of their own.

Ms. Taylor: KCDC administers public housing, the Section 8 Housing Choice voucher program, and the Section 8 Moderate Rehab program. Mod Rehab (these are “project based vouchers,” and as such are tied to a particular facility) is an old program and is being phased out. There are presently only 82 Mod Rehab units in Knoxville/Knox County.

There are about 3600 Section 8 Housing Choice vouchers in Knox and Knox county. Section 8 Housing Choice is federally funded, and the program allows people to seek housing with private market landlords. Landlords select a tenant, fill out the appropriate paperwork, KCDC inspects the apartment, and if it’s deemed to be acceptable, then the landlord enters into a contract for that apartment with KCDC. The landlord enters into a lease agreement with the tenant. KCDC does not control the lease. It is the landlord’s responsibility to screen the tenant. If a tenant using a voucher is evicted for reasons related to crime, then KCDC will terminate the assistance.

KCDC issues 50-100 vouchers per month. Their priorities, in this order, are: people displaced from their housing by government action (construction projects, renovation of housing development, etc.); people displaced from their housing involuntarily (domestic violence is one example of this); people who are homeless; people who are disabled. Since June 2010, KCDC has housed 516 families (a “family” can have only one member, and so might be a single individual). 366 of those people came right off the streets. The rest were disabled. If you would like to know all about eligibility requirements, click here to view complete eligibility information here on KCDC’s website.

Demand for housing assistance is high. Every day, KCDC receives applications from people seeking vouchers.

The voucher program receives funding around March of every year. Sometimes the level of funding is sufficient that KCDC can just keep on issuing vouchers, but KCDC cannot under any circumstances exceed 3667 units in a year. Once a tenant is housed, they can remain in their housing until HUD cuts funding.

At this moment there are about 300 vouchers that have been issued in Knox. The people who were issued those vouchers are out on the street looking for housing. There are over 800 landlords in Knox County who accept vouchers, and a lot of them operate multiple units. 800 may sound like a lot, but keep in mind that their properties are often extremely small. There is a great need for affordable housing in our community.

KCDC educates people about housing resources available to them in the community For example, when people are looking for information about affordable housing, KCDC directs them to Tennessee Housing Search, a website that a lot of landlords use to list their housing. And KCDC also has literature for people at their offices.

There are over 3600 units of public housing in Knoxville. There is a very long waiting list for those, just as there is for Section 8 Housing Choice vouchers.

Ms. Taylor concluded her remarks and said that she would welcome questions about the Section 8 program. Ms. Adams introduced Billie Spicuzza and Alvin Nance at this point in the conversation, and mentioned that they are here to answer questions about, too.

Ms. Adams ended the presentation phase of the conversation and moved it into question and answer.

Councilman Della Volpe: KCDC’s direct relationship is with the landlord. Does KCDC continue to supervise quality of housing? Taylor: We inspect once a year as part of the recertification process, and each year the tenant has to be recertified too. We also interface directly with tenants’ neighbors. If we get a complaint, we contact the landlord, and where appropriate, law enforcement.

Councilman Grieve: How is the number of vouchers issued to Knoxville determined? Taylor: There are federal NOFAs (notices of funding availability) issued annually. We can apply for however many vouchers are made available in the NOFA. I also want to make clear that as far as KCDC is concerned, there is no distinction in types of homelessness. For purposes of our local preferences, we don’t distinguise between chronic homelessness and other types of homelessness.

Question: I come from Boston, originally. It sounds to me like you have a lot of vouchers in Knoxville. How many are project based? Taylor: None are project based anymore. Housing Choice vouchers simply go out into the market. Question: Is there a specific neighborhood oriented group that can give people info about how to get a voucher. Taylor: Our office is located in the Old Vine Middle School. They come in to apply. They are called in to a briefing, and that’s where they learn what they need to do.

Councilman Brown: How do you contact people who are on the waiting list? Taylor: They have to have an address. That could be at KARM, for instance. We have a good working relationship there. Most prospective tenants have some contact info. The vast majority of them are not very hard to get in touch with.

Ron Peabody: Of the 800 landlords you have, how many units does that represent in total? Taylor: Several landlords have multiple units. Peabody: Of the 366 vouchers issued since June, the bulk of those, how were they certified homeless? Taylor: Any social service agency can verify homeless status. Peabody: How will Hearth Act redefinitions affect availability? Mike Dunthorn: The Hearth Act was passed by Congress to make changes to McKinney Vento, but HUD hasn’t yet issued regulations. I understand your question, and it can’t be answered until the regulations are issued. Linda Rust: The definition of chronic homelessness will change to include families. Billie Spicuzza: HUD determines eligibility. They issue regulations that define eligibility for assistance. When that happens, we change how we make offers of vouchers. It won’t expand our number of units available, but it will reshuffle priorities. Rust: Hopefully HUD will make accommodation for that. Maybe there will be vouchers made available to help people in those new categories.  Spicuzza: I don’t see a great impact on us. We’ll simply continue to house those people who continue to apply.

Councilman Della Volpe: Among the people housed by KCDC since June, is there a number that reflects the percentage in the total number housed who were homeless? Have you interfaced with HMIS (the Homeless Management Information System database) to find out how many were chronically homeless? Taylor: When we bring people in, we don’t distinguish types of homelessness. There are three preferences: Displaced by government action, involuntarily displaced, and homeless— doesn’t matter what kind. Then, permanently disabled. They apply for a voucher with verification of status. All of those services that verify homeless status use HMIS.

Councilman Grieve: The people moving into Minvilla right now—are they using vouchers? Will the rest have vouchers? Taylor: 12 do have vouchers. Anyone who has a voucher right now could move into Minvilla.

Joe Minichiello: Does my addiction have any effect on my application for assistance? Taylor: All applicants are screened. If any illegal drug activity has occurred over the last three years, the application will be denied. KCDC also screens through KPD and NCIC.

Question: Are there geographical restrictions for landlords? Taylor: That’s a good question. For KCDC, property has to be within in the Knox County. Others rental assistance providers, such as THDA and ETHRA, house outside Knox county.

Councilman Brown: Do you keep stats on people who come in homeless and then later become employed, and move back into society? Alvin Nance: That information is in our system and is used for purposes of recertification. We don’t mine the data, though, to track trends or anything like that.

Linda Rust: Do you get a lot of complaints about behavior? Taylor: No. Some weeks we get zero complaints, and others we get two or three. We subsidize rent, but we don’t enforce the lease. We’re not the landlord. It’s up to the landlord to enforce lease. If we get a complaint about a tenant’s behavior, we contact the landlord about their tenant. The lease is between tenant and landlord. Rust: Are there any landlords who have a preference for tenants who have case managers? Taylor: Anytime a tenant has a case manager attached to them, it’s a good thing for the landlord. They don’t tell us that, but that’s my opinion.

Councilman Della Volpe: Do you ever decertify landlords because they’re not doing a good job? Taylor: I’ve done that twice.

Peabody: My understanding is that tenants in the Section 8 program, if they’ve got income, they can actually only take up to 30% of their income. Taylor: If a tenant has income, they’ll pay no more than 30% of it for rent. If they rent a more costly place, HUD will let them spend up to 40%. Our voucher payment standards are 100% of fair market rent. Billie Spicuzza: All units don’t rent for the same amount. We compare a unit to other units like it, and we won’t approve you to get rent greater than what someone who’s not a subsidized property is getting. We’re never paying more than a private landlord is getting. We negotiate with the landlord.

Question: Is there a mechanism by which a landlord can lose a Section 8 contract due to neighborhood complaints? Sometimes landlords don’t care about what goes on with their property. Taylor: You can contact us and complain, and we’ll investigate, and if the landlord’s not doing what he’s supposed to do via the tenant, then he’s in violation of his contract.

Ron Peabody: Do you know how many chronically homeless you have housed? Mary Thom Adams: That question has already been answered. Peabody: How many different social service providers can get tenants into housing through KCDC? Taylor: Any social service agency can.

Joe Minichiello: Is there is a higher incidence of police activity among Section 8 voucher users? Lieutenant Pappas (of the Knoxville Police Department): Our investigation doesn’t uncover whether or not a person is using a voucher. We don’t ask a person, “By the way, are you using a voucher to help with the rent?” We just don’t capture that.

David Massey: Case managers have been assigned to some KCDC tenants, and the success rate for those tenants has been very high. Before, people who had been homeless turned over really fast. Having case managers has prevented people falling into homelessness again or being evicted to the streets. Mike Dunthorn: CAC has provided case management services in some KCDC towers. Prior to that program’s implementation, there’d been about 67 evictions per year. That’s now down to zero evictions to the street. Case management has clearly proven itself effective.

Ron Peabody: I thought the homeless were at the top of the preference list. Billie Spicuzza: KCDC’s local preference choices for the homeless have existed for a long, long time. If there were a disaster, or a road project, or something like that, then priorities would shift. Alvin Nance: It’s important to understand that the preferences we’re using are much older than the Ten-Year Plan, which isn’t a regulatory agency anyway. KCDC is federally funded, and we have regulatory oversight that’s not local.

When: Wednesday, November 17, 2010 – 6:00pm

Where: New Harvest Park

Contact: Robert Finley, 215-3071

The Office of the Ten-Year Plan to End Chronic Homelessness would like to invite the public to a conversation at the New Harvest Park community building from 6pm until 7pm on Wednesday, November 17. New Harvest Park is located at 4775 New Harvest Lane, 37918.

The topic of this public conversation will be KCDC (Knoxville’s Community Development Corporation) and how it helps to make affordable housing available to qualified residents in Knoxville and Knox County. We will pay special attention to housing for people who have experienced homelessness. Deborah Taylor, KCDC Section 8 Director, will present for the first half-hour with a moderated Q & A to follow.

This is the seventh in a series of similar public conversations. We will continue to offer them on a regular basis. We do not plan to hold a public conversation in December due to the fact that most people’s schedules are so full around the holidays.

We plan to announce our next public conversation in January 2011. We like to keep these meetings concise to respect the time of attendees and invite presenters who can speak to their areas of expertise and to the roles that they play in support of the TYP. We’ll open up the floor for questions and conversation on the specific issue being addressed, and we’ll ask attendees for ideas about subjects they’d like for us to address in future public conversations.

Comprehensive notes from all public conversations like this one are posted here.

The TYP held its sixth Public Conversation at 6pm on Wednesday, September 22, 2010 at the Cansler YMCA. The topic was “Who are the Homeless?” Mary Thom Adams, a supporter of the TYP who works in development with Positively Living Park Ridge Harbor, Knoxville’s largest dedicated permanent supportive housing facility, acted as moderator. Dr. David Patterson, Director, Clinical Doctorate Program and Professor in the University of Tennessee, Knoxville, College of Social Work; Stacia West, M.S.S.W., Data Analyst; and Jennifer Lantz, M.S.S.W. Intern delivered a presentation about the homeless population in Knoxville and the Homeless Management Information System (KnoxHMIS), the database used to gather information about people experiencing homelessness in Knox County. The meeting was attended by approximately 45 people and the conversation, once again, was respectful and informative.

Notes

[These are my notes combined with material presented by Dr. Patterson and his team. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post. Please tell us who you are and where you live.]

Attendees included several City Councilpersons: Vice Mayor Bob Becker, Daniel Brown, Duane Grieve, Nick Della Volpe and former Councilman Barbara Pelot. Former Knox County Commissioner Finbarr Saunders was present. My apologies if I’ve missed anyone. The format of this meeting was one hour. The first half hour was used for presentation. The second half hour was for conversation with attendees.

Ms. Adams, in her role as moderator, focused this meeting’s topic on the demographics of homelessness in Knox County. She asked Jon Lawler, TYP director, to introduce the presenters. Lawler said that the reason that people with chronic homelessness are getting into housing and succeeding there is that the service provider community here in Knox County is made up of great partners. UTK’s College of Social Work is one of those partners, and is a critical part of the work our community is doing to end chronic homelessness. A little over five years ago, there was no centralized data collection system to help us get our hands around the issue of homelessness. Now, there is, and KnoxHMIS is a vital tool. Lawler thanked Dr. Patterson for presenting and the audience for attending.

Dr. Patterson: Thanks for taking time to come out. Introduced Stacia West, Data Analyst; and Jennifer Lantz, Grad Student in Social Work. Patterson discussed what Knox HMIS is. The US Department of Housing and Urban Development (HUD) tasked local communities with developing unduplicated counts of clients served at the local level. HMIS is the direct response to that. HMIS analyzes patterns of use of people entering and exiting the homeless assistance system, and evaluates the effectiveness of these systems. Essentially, HMIS documents who the homeless are and how they’re being served in our community. Back in 2004, KnoxHMIS started collecting data. To date, over 20,000 have been entered into KnoxHMIS. All of these are either homeless or on the verge. KnoxHMIS is a collaboration between the University of Tennessee, the Ten-Year Plan, the City of Knoxville, Knox County, and HUD.

KnoxHMIS is used by 12 participating agencies right now. Its web-based secure database and software links these agencies. Individuals must give their permission for their personal information to be entered into HMIS, and compliance is very high. You are only entered in HMIS if you give permission AND you receive services at a participating agency.

KARM (Knox Area Rescue Ministries) is a big part of KnoxHMIS’s success and usefulness here in Knox County. It is unusual for rescue missions to participate in HMIS. Knox is different in that here, the mission is a full partner in our HMIS. That’s good because it improves our rate and quality of information capture and it gives people an incentive to participate in HMIS. KnoxHMIS participants can be given front-of-the-line preference for meals and beds as an incentive to participation.

KnoxHMIS provides a platform for inter-agency collaboration around services provided to shared clients because it allows users to see what services are delivered to a given client by other agencies. The database helps to coordinate case management across the community. It allows case managers to share case notes and track the history of clients’ experience with homelessness. The goal is to make HMIS integral to the way our community provides services and shares information between homeless service providers. That goal is being realized.

Who is Chronically Homeless? The HUD definition: an unaccompanied disabled individual who has been homeless for at least one year or who has had four episodes of homelessness in the past three years. Patterson underscored that it is critical to note the presence of a disabling condition.

Patterson discussed information about chronically homeless individuals as new clients. There has been a decline of people who meet HUD’s definition of chronic homelessness AND who enter the system as new clients. There are others who are “active clients:” they meet the criteria for chronic homelessness and have received services. KnoxHMIS data seems to suggest that homeless services provider agencies are doing a better job of engaging people who are chronically homeless.

The average chronically homeless person in KnoxHMIS is a single, white male age 46, has a high school education, has never been to prison, is from Knox County, reports his primary reason for homelessness as loss of job, is not a military veteran, and reports to be in good health in comparison to other people his age.

The average homeless (not chronically homeless) adult female in KnoxHMIS is a single, white female age 39, from Knox County, has a high school education, has never been to prison, reports her primary reason for homelessness as domestic violence, and reports to be in good health in comparison to other people her age.

The average homeless (not chronically homeless) adult male in KnoxHMIS is a single, white male age 42, from Knox County, is homeless for the first time, has a high school education, has never been to prison, reports his primary reason for homelessness as loss of job, is not a military veteran, and reports to be in good health in comparison to other people his age.

The average homeless child in KnoxHMIS is 8 years old, accompanied by a single mother, and in a family with 1.65 children. The mother’s self-reported primary reason for homelessness is domestic violence

Patterson stated that the idea that most homeless people in Knox County are not from around here is simply incorrect. It is a basic fact is that 79% of the individuals in KnoxHMIS in 2009 are from Knox County or the contiguous counties as per their last permanent address. 59% of them indicate their last permanent address in Knox County. The data in KnoxHMIS undermines the myth that they’re all from somewhere else. Patterson went on to say that KnoxHMIS is asking a slightly different question (What’s the zip code of your last permanent address?) from the one asked in Dr. Roger Nooe’s biennial study (Where are you from?) which many respondents probably interpret as “Where were you born?”

Why do people fall into homelessness in Knox County? Most of the reasons self-reported are related to economic issues. Loss of job, lack of affordable housing, etc., are dominant reasons. With people experiencing chronic homelessness, substance abuse is a more notable reason. If you look at lifetime prevalence of mental illness, 48% in the general population will exp a diagnosable mental illness, and 15% will experience a significant substance abuse issue. Keep this in perspective.

44% of homeless in Knox experience a disability. Disability is a primary characteristic of homelessness.

23% of active clients in KnoxHMIS are employed.

From Jan 1, 2010 to the present, KnoxHMIS data show that 3251 individuals sought services in Knoxville for the first time. 31% of these were children, which is up dramatically. There is a 31% monthly increase in the number of people entering homelessness.

Ms. Adams ended the presentation phase of the conversation and moved it into question and answer.

Dave Gartner: How do you interpret disability type? Patterson: This info is on the handout sheet (as shown below). Disability is not limited to mental illness and substance abuse alone. The following percentages are reported by case managers; they are not self-reported.

Vice Mayor Becker: Is 8% homeless vets high or low or comparable to other places? Patterson: Nationally it’s about 12%. That’s been fairly consistent over time.

Question: What percent don’t agree to participate in KnoxHMIS? Patterson: Very few don’t participate. There was initial concern that lots of people would refuse. Our experience shows that non-participation is close to zero. We’ve built in incentives to participation, such as being able to get certain services faster than people who don’t participate.

Councilman Della Volpe: The causes of homelessness right now are mostly economic. If you looked back a year or two before 2008, would you find different kinds of causes? Patterson: I hesitate to speak of this in terms of causality.

Question: Is there any sort of police check to verify criminal history? Patterson: That’s not inherent in HMIS. That is left up to discretion of individual agencies.

Councilman Della Volpe: How do you determine last permanent address? Are you really talking about contiguous counties? Patterson: Yes to the latter: we are talking about contiguous counties. Last permanent address is identified by zip. It’s a HUD question: What is the zip code of your last permanent address?

Councilman Brown: Do you have info on other races, Hispanic? Stacia West: The percentage of Hispanic individuals who enter the system is very small in Knox, probably around 2%. They just don’t come in for services at a very high rate.

Will Donegan: Is anyone in the community trying to organize homeless people into associations? Ginny Weatherstone: I’m not aware of anyone doing that. Julie Winklestein: There are groups doing that online. Bob Becker: I have heard that there are efforts to organize day laborers in Nashville and Memphis.

Vice Mayor Becker: How many of the chronically homeless have a mental illness? Stacia West: 34% have a mental illness.

Joe Minichiello: There is a discrepancy in your data on the handout sheet. Stacia West: We have to deal with null data. That 14% represents a formula that is used to account for null data in KnoxHMIS. Patterson: There’s a box you check for “chronically homeless” and it doesn’t get checked sometimes, and when that happens, that’s “null data.” The information is applicable to clients who specify their status as chronically homeless. Question: Is the null data in the 14% or the other number? Patterson: It is omitted in the 14%. Stacia West: Both are accurate. They’re two different ways of looking at the same information. The percentage is valid as is the raw number. We can give you the data and you can draw your own conclusions. 14% or 896. 247 new, 14% are new.

Question: When it says “not chronically homeless,” what does that mean? Patterson: That refers to the general population of the homeless. Homeless people who are not chronically homeless by definition are members of the general population of the homeless.

Councilman Della Volpe: Is there a number that indicates employability? Patterson: That is a great question. 44% have a disability. Perhaps we should take those out and assess the 56% who do not have a disability. On the other hand, that would assume that disabled individuals can’t work, and that would be wrong.

Question: Once a chronically homeless person is in housing, what are they considered to be? Patterson: They are no longer homeless if they reside in permanent housing, but if they’re still receiving services, they’re still in the system. Question: How will you characterize people who are no longer homeless but still need help? Patterson: We can specify which chronically homeless people have been housed.

Question: What does employment mean? Patterson: It can mean full time employment, odd jobs, collecting cans, any sort of legitimate employment.

Will Donegan: Is anyone studying the relationship between substance abuse in subsidized housing and homelessness? Patterson: We want to study that relationship and applied for a grant to fund that study, but our funding application was unsuccessful. We’re on the edge of proposing another such study. Donegan: There’s a concern among some members of the public that permanent supportive housing for the homeless will enable substance abuse somehow. Patterson: I have taught substance abuse treatment for nineteen years. The best available evidence suggests that people who are actively using substances decrease their substance use when they are in housing, and that trend continues over the duration of their time in housing. Question: Why is that? Patterson: Well, my best guess is that people living on the street want to numb that reality. When people get into housing other things become more important to them.

Question: Isn’t it true that when people with substance abuse issues get into supportive housing that they have fewer other health issues so that they need fewer other services like the kind you get at hospital emergency rooms? Patterson: Yes, and a study conducted in Seattle and recently published in the Journal of the American Medical Association Seattle points to just this fact.

Question: Within the housing first model don’t you usually have case managers to help with issues like substance abuse? Ginny Weatherstone: Yes. That is certainly true in permanent supportive housing as we know it and do it in Knox County. The case manager assists the newly housed individual to address those issues in an appropriate way. They do it together.

Vice Mayor Becker: Most homeless people in your presentation report good health in comparison to other people their age. That is surprising to me. How could that be? Are there data that support that, or is it just self-reported? Patterson: It’s self-reported. But we know that people living on the streets have much higher incidences of indicators of poor health.

Julie Winklestein: Wasserman says that a lot of people who use alcohol and drugs don’t start until they hit the streets. Patterson: That’s possible I don’t know. Question: Maybe when they are first asked, they’re healthier than later. Are they only asked once? Patterson: Yes.

William Donegan: I’m under the impression that Dr. Nooe’s studies have been a real catalyst to the efforts here in Knox County. Patterson: Yes, very much so. Donegan: I wonder if there was a similar interest in studying substance abuse if that would help with that?

Bill Snyder: Did Nine Counties One Vision look at homelessness? Linda Rust: I don’t think there are any other places in the nine counties that were as far along as we were, so I don’t think it was really a part of the whole Nine Counties One Vision Process. Barbara Pelot: I think we were just waking up to the issue at that time.

Question: In the past couple of years, pills have become more commonly abused. Is there any data on that? Patterson: We don’t collect that directly.

Question: I’d like to see a show of hands of anyone who’s actually been homeless or struggled with addiction? (Not many hands are raised.) I did lose a job, became homeless, addicted, and I’ve overcome those challenges and am off the streets. Now, I’m noticing that the causes of homelessness have not actually changed. Can this database be used to help people find a job? Patterson: There are agencies that are actively helping people to seek employment opportunities across the county.

Next meeting: new location

The next public conversation is scheduled to take place from 6-7pm on Wednesday, November 17 at New Harvest Park, located close to Knoxville Center Mall. Deborah Taylor of KCDC will discuss the role KCDC plays in making affordable housing available to people who need it, including people who are leaving the streets and moving into permanent supportive housing. We’ll follow the same basic format as usual. First half hour presentation, second half conversation about the subject. Please plan to attend.

What: Ten-Year Plan public conversation: Who are the homeless?

When: 6 p.m. until 7 p.m., Wednesday, September 22

Where: Cansler Family YMCA, 616 Jessamine Street

The Office of the Ten-Year Plan to End Chronic Homelessness would like to invite the public to a public conversation at the Cansler Family YMCA. The topic will be Who are the homeless? and the presenters will be Dr. David Patterson of the UT College of Social Work and members of his staff. Mary Thom Adams once again will moderate.

A lot of this particular conversation will focus on HMIS, the database vital to understanding people experiencing homelessness in our community. We’ll follow the same basic format as usual. First half hour presentation, second half conversation about the subject.

This is the sixth in a series of similar public conversations.

We will keep these meetings concise to respect the time of attendees. We will continue to offer them on a regular basis, and invite presenters who can speak to their areas of expertise and to the roles that they play in support of the TYP.

We’ll open up the floor for questions and conversation on the specific issue being addressed, and we’ll ask attendees for ideas about subjects they’d like for us to address in future public conversations.

Comprehensive notes from all public conversations like this one are posted on this very website and are tagged “public conversation.”

The TYP held its fifth Public Conversation at 6pm on Wednesday, August 25, 2010 at the Cansler YMCA about addiction, addiction treatment, and how both of those relate to the TYP. Mary Thom Adams, a supporter of the TYP who works in development with Positively Living Park Ridge Harbor, Knoxville’s largest dedicated permanent supportive housing facility, acted as moderator. Hilde Phipps, Director of Adult Addiction Services, Helen Ross McNabb Center, discussed the nature and effects of mental illness, treatment options provided by Helen Ross McNabb Center, and other treatment modalities available in the community. The meeting was attended by about 45 people and the conversation, once again, was respectful and extremely informative.

Notes

[These are my notes. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post. Please tell us who you are and where you live.]

Attendees included several City Councilpersons: Vice Mayor Bob Becker, Marilyn Roddy, Nick Della Volpe and former Councilman Barbara Pelot. County Commissioner Finbarr Saunders was present, too. Ten-Year Plan staff were present as were Grant Rosenberg and Linda Rust of the County’s Grants & Community Development department. Several members of the service provider community were also present, including Volunteer Ministry Center’s Ginny Weatherstone and Gabe Cline; Helen Ross McNabb Center’s Leann Human-Hilliard; and Stacia West with Knox HMIS (Homeless Management Information System); and Steve Jenkins, Positively Living/Parkridge Harbor. My apologies if I’ve missed anyone.

The format of this meeting was one hour. The first twenty minutes were used for presentation, the second forty minutes hour was spent in open dialog.

Ms. Adams, in her role as moderator, focused this meeting’s topic on addiction and homelessness. She introduced Ms. Phipps and her topic. Ms. Phipps is the Director of Adult Addiction Services for Helen Ross McNabb Center. Ms. Adams focused the purpose of the meeting: The first half hour is reserved for presentation and the following half hour is reserved for discussion. We’ll stick to the topic: addiction and chronic homelessness.

Ms. Phipps introduced herself. She has worked for eighteen years in the field of addiction treatment and loves her work. She said “I’m here to talk about addiction in our community and the availability of resources to treat it.”

What is addiction?

Ms. Phipps defined addiction:  Addiction is a chronic progressive illness that if left untreated is fatal, but if the illness is arrested at any point in time the addict can be restored to healthy, productive living.

• Chronic means that the disease is ongoing
• Progressive means that it gets worse over time unless treatment occurs. More on this below.
• With appropriate treatment, the illness of addiction can be arrested at any time in its progression, and the addict can be restored to productive, healthy living.

Impact of addiction

Addiction is very widespread and cuts across all societal boundaries. One in every four families is effected by addiction, and the effects can be devastating. BUT there is hope and there is the very real potential for recovery. Addiction does not have to be fatal, but it is always going to be painful. The illness effects sufferers physically, mentally, emotionally, spiritually. Addiction has a profound impact on every part of life and on every kind of ability.

Why are all of these areas effected? It’s a chemical issue. Something happens in the brain that tells an addict that he or she has to have the addictive substance in order to feel normal. The substance becomes necessary to survive.

Many kinds of substances can be addictive. Alcohol is still a commonly abused and very addictive substance. Opiod addiction is more and more common now because of the ready availability of prescription pain medication. Other kinds of psychoactive drugs can become addictive.

Factors that create the opportunity for addiction

Addiction has a physical component and a psychological component.

Genes: To become an addict, as opposed to someone who simply abuses substances without becoming addicted, a person needs a genetic predisposition to addiction. For example, the grandson of an addict is five times more likely to get addicted than is a member of the general population. Ms. Phipps pointed out that it is really hard for the general public to understand this. It’s not simply an issue of self control. One in four people have this genetic predisposition to addiction.

Access: The average age of first use is 12 years of age. In other words, the average addict has access to a substance that is addictive when he or she is very young.

Amount: To cross the line that separates the addict from the non-addict, you have to ingest a certain amount of the chemical to which you are addicted. And nobody knows how much this is. It’s a biologically-determined thing that is unique for each individual. A person might be able to ingest a substance fifteen times or fifteen hundred times before he or she becomes addicted to it.  Nobody can predict where that threshold lies, and nobody wakes up and says “I think I’ll become a destructive addict today.” If we knew where the magic line was, everyone would simply stop before they got to the line. We just don’t know where that is, but by the time you cross it, it’s too late. Once a cucumber becomes a pickle, it can never again be a cucumber.

Ms. Phipps stressed that this is not a moral issue. Once the line is crossed, the relationship to the drug becomes the very most important relationship in life. The pleasure of using the substance is gone after the first couple of years. The addict will still chase that original high, but can’t catch it, and are miserable and tormented. They keep using more of the substance to try to recapture the original high. They can never get there, but they need to use more and more of the substance to try, they have to keep using the substance to feel normal, and thus the disease progresses.

Medical Detox: Duration–five to twelve days.

Residential Rehabilitation: Duration–21-28 days.

Certain substances will kill you if you try to get off without medical help. Alcohol, opioid drugs, benzodiazepines like Xanax, Halcyon, etc., are among those, and necessitate medical detox and residential rehab. These drugs aren’t inherently bad. When used properly, they’re extremely beneficial, but some people simply can’t use them without becoming addicts.

If addiction sets in very early in life, then recovery is more difficult because the addict has not developed coping skills earlier in life. Teaching daily living skills is a very important aspect of treatment. We give people chores not to punish or penalize them, but to start teaching about how to live with daily routine. Very busy and highly structured because they don’t have the ability to structure their own lives.

There is a direct correlation between the length of time in treatment and success in recovery.

Addiction sets us up for a lot of moral judgment. Part of what we do is to educate families and others who are affected by the illness. There is tremendous hope. If arrested, restoration is possible. Chemical dependency alone is stigmatized among illnesses. Most people have a choice about substance use in the beginning, but the addict loses the choice when he or she crosses the magic line.

Q: What is the connection between addiction and homelessness? Is there a connection?  Ginny Weatherstone, CEO of Volunteer Ministry Center: Let me dovetail and feed back. The ramifications of addiction are severe and they effect every area of a person’s life. I think an addiction definitely can lead to homelessness. Ms. Weatherstone asked Ms. Phipps if she would concur?  Ms. Phipps: 70% of all addicts are in the workplace, and obviously not all of them are homeless. But of course, if addiction damages a person’s ability to work, it will damage their ability to maintain a house payment or to pay rent. Ms. Weatherstone: I agree. The impact of addiction on relationships can also effect the ability of a person to remain in his or her family. When a person begins to ask how they can end the cycle of addiction, one of the answers will be the kind of treatment that they can get at Helen Ross McNabb Center. That’s why people experiencing homelessness and residents of supportive housing will be referred to their programming. Gabe Cline, VMC: The first thing I feel compelled to say about this is that by no means are all homeless people addicts.  Part of what we do from the case management perspective is to look at the whole person. If addiction is an issue for you, we’ll work to get you connected with addiction experts, like those at McNabb. But we’re also looking at mental illness, housing, and other issues and the services available to help with them. People who are experiencing both homelessness and addiction live with a level of chaos that makes it very hard to follow an addiction treatment plan, to manage all the moving parts of a very chaotic life, while they are living in the streets. My experience is that housing plays a huge and very positive role in recovery.

Q: Bob Becker: You have spoken about what addiction is and that it can be cured. What gets you back on the other side of that line, out of addiction? Ms. Phipps: The first phase is medical intervention. That’s going to take a matter of a few days. That’s treatment. The next phase is longer term residential: 21-28 days. We don’t say that an addict is “cured.” We say that an addict is “in recovery,” and that’s what we try to draw people towards. We help them gain the skills they need to do things for the first time without using the substance to which they’d been addicted. How do you face the firsts of your life without using? How do you have fun? Attend a funeral? Go to work? Those are things you learn on the way to and during recovery. We encourage participation in recovery groups such as AA and NA and others. Recovery is a lifelong commitment.

Q: Dan Brown: Oftentimes in these sessions, we’re given the example of people who are homeless because they’ve gone OFF their meds. Is there a statistic that differentiates between that and becoming addicted? Could a person come off their meds and then become addicted to another substance? Ms. Phipps: There’s a difference between drugs and medications. Drugs are being used improperly. Medication has been prescribed by a health care or behavioral care provider for a certain set of symptoms. We encourage people to use medications. I think you’re talking about people using psychotropic medications. We encourage them to stay on those, and to use them properly, as prescribed, because they’re helpful.

Q: William Donegan: I’ve thought about this a lot. The fellowship of the recovery program is key and could be emphasized at this point. Involvement in community can reduce one’s need to find an external substance to medicate pain, because community and a sense of belonging can help with that pain. Gabe Cline: Community is helpful whether we’re talking about addiction or just alienation. There’s not good community on the street. Much of what we’re doing at Jackson Apartments and Minvilla is about building good community. We want residents of these apartments to learn to engage in healthy ways with the folks they live with. We encourage involvement in Circles of Support and other constructive and healthy groups. We emphasize skills development, too, in supportive housing. Mary Thom Adams: Would most supportive housing programs do the same things you’re describing? Ms. Cline: All of the supportive housing programs that I know of are doing that. Quality of life requires people connecting with other people.

Q: Eleanore Ripley: I am a recovering alcoholic. The smell of alcohol is still a trigger for me. Say for example that a person goes to Helen Ross McNabb Center for treatment. They finish and go into supportive housing, and their neighbor might be drinking. Have you made plans to accommodate that person so that you remove that trigger? Might a wing in an apartment building have a no alcohol policy, even if the whole facility is not a “dry” facility? I don’t know how else you would ensure that that person would be protected from relapse. My father was homeless in Knoxville for years. I wish there could be some way that once they go through treatment, they would not have to worry about their neighbor having a beer. Ms. Phipps: Triggers are as individual as people, and they might seem completely unrelated to the substance. For example, the trigger for some clients is a particular song. We can’t remove every trigger from every environment, not even in a treatment setting. We can’t remove them all, but we do all we can, especially in the early, most fragile time. Mary Thom Adams: Talk about VMC’s program. Ginny Weatherstone: I concur with Eleanore. If you’re recovering from addiction you don’t need to return to your old playgrounds. Can you remove all of the triggers from a given environment? I don’t know. All I can speak of is Minvilla, and there’s one part of the building where we could maybe control for that, but that remains to be seen. Leann Human-Hilliard: I oversee some of Helen Ross McNabb Center’s housing. Ours permits no alcohol on the premises. We struggle with that internally, but for us, that is what we have made the decision to do. We’re not out looking for violations of this policy, but if it becomes a problem, we address it; it’s part of their lease. Eleanore Ripley: Are you saying that there’s no alcohol and drug use allowed on the premises in housing for the homeless? Ms. Human-Hilliard: It’s whatever the people running the housing decide and how they set up their lease. Ms. Ripley: I’ve read that it’s allowed in TYP housing. Ms. Weatherstone: The true definition of housing first does not require sobriety at move-in. What research shows is that in housing, usage goes way down and residents with addiction issues are better positioned to succeed in treatment than are people with addiction issues who remain on the streets.

Q: Is Helen Ross McNabb Center part of the TYP?  Ms. Human-Hilliard: The TYP is a document, and it is one that I can fully support. Permanent supportive housing is what we need to move towards as a community.  The way that Helen Ross McNabb Center moves towards providing that type of housing might look different than the way another provider moves towards it.  Ms. Adams: So the TYP does not lay down rules and regulations for providing supportive housing. It’s about coordinating the efforts of the different providers in the community. Jon Lawler, TYP Director: The TYP is about working with different agencies while respecting their distinctives. But the DNA of supportive housing will be the same as it expresses itself across all the agencies. Mike Dunthorn, TYP Staff: Each individual’s needs are assessed and that assessment helps to determine the best housing placement to meet the needs of the individual. Different agencies bring their own approaches to the table, and what’s best for one person might not be for another. One size does not fit all, and variety is a good thing within the basic framework of supportive housing. The TYP respects that.

To hopefully further clarify this point, I posted the following at KnoxViews on Friday, August 27. “Helen Ross McNabb Center, Peninsula, Volunteer Ministry Center, The Salvation Army, and just about every other service provider that I could name have been around a lot longer than the TYP. The TYP does not control or “regulate” these various agencies. Let me attempt to be very clear here. At its most fundamental level, the TYP exists to reorient a system that has historically focused on managing homelessness into a system focused on ending homelessness. The TYP is about helping those who work within that system to coordinate their efforts to maximize their effectiveness and to minimize cost.”

Q: Is the Flenniken project a TYP, a City or a County project?  Vice Mayor Becker: The project will be managed by VMC and there will be a lot of different funding sources involved in making it work. And, back to Dan Brown’s question–please address the question of how many are addicted when you do next public conversation.

Q: William Donegan: Will statistics be created that can be used to assess the success rates and recovery rates of people in supportive housing?  Stacia West, HMIS: We can talk a lot more about that in the next few years as we continue to input data into HMIS.

Q: In re. stats for recovery from addiction: recovery from addiction happens at a very low rate. What would be the stats for a situation like one we’re talking about here? Is there a difference between treatment for people who are homeless and people who are not? Ms. Phipps: It’s the same treatment regardless. People don’t come to treatment because they see the light, they come to treatment because they feel the heat. And it’s not what gets you through the door that determines outcome. The stuff we do is basically the same for everyone, but we know that some therapeutic modalities work better for some populations. Nationally, the addiction recovery rate is 20%. Ours at HRMC is around 60%. The longer a person is engaged in the process, the better the outcome. Everything that we can wrap around them is gonna help the outcome.

Q: Joe Minichiello: What is your position on no-barrier housing (active addiction when you enter the program)? What are their chances for success? We’re allowing people to drug and drink themselves to death in supportive housing. Ms. Adams: I think I’ve heard that question answered. The TYP is not a policy, it’s a document. There are 6-7 agencies that provide permanent supportive housing in this community. Is it possible that they might operate in different ways?  Mr. Becker: It paints the picture of diversity. Housing and recovery are not the same thing. Ms. Weatherstone: Drinking and drugging themselves to death is what happens on the street. When they don’t want to do that anymore, they make the decision to stop the suicide by street and work with a case manager and get out of that cycle. Ms. Adams: Are you saying that when a person gets into permanent supportive housing, they’ve made a decision to get out of homelessness and to seek help for their addiction, if that’s their issue? Ms. Weatherstone: Yes, at VMC that is precisely the case. Ms. Adams: I think your question has been answered, wouldn’t you agree? Mr. Minichiello: Yes.

Q: Eleanore Ripley: So, how many times do people get to cycle back through all this? Gabe Cline: We would be leaving lots of people on the street if we had one-strike and you’re out policy. You must be living by terms of lease if you want to keep your housing. There can be no illegal activity. If a person goes back to the street life, they will probably lose their housing as a natural consequence of choosing to go back to that life. From the perspective of good case management, as long as that person is still working towards recovery, I’d hate to set up a situation that they’d lose their housing just because they relapse. If they stay in it with us, we want to keep them. Ms. Human-Hilliard: We all want to allows for more of a harm-reduction model to be in place. Reducing harm over time is very helpful and effective, over time.

Next meeting

The next public conversation is scheduled to take place at the Cansler YMCA from 6-7pm on Wednesday, September 22. The topic will be Who Are the Homeless? and the presenters will be Dr. David Patterson of the UT College of Social Work and members of his staff. A lot of this conversation will focus on HMIS, the database that is so helpful in helping us to understand people experiencing homelessness in our community. We’ll follow the same basic format as usual. First half hour presentation, second half conversation about the subject.

The TYP held its fourth Public Conversation at 6pm on Wednesday, July 21, 2010 at the Cansler YMCA about mental health services and the role they play in relation to the TYP. Mary Thom Adams, a supporter of the TYP who works in development with Positively Living Park Ridge Harbor, Knoxville’s largest dedicated permanent supportive housing facility, acted as moderator. Sheryl McCormick, Coordinator, Recovery Training Services at Peninsula, delivered a thorough presentation about the nature and effects of mental illness, with a primary focus on treatment options in the community . The meeting was attended by approximately 45 people and the conversation, once again, was respectful and extremely informative.

Notes

[These are my notes combined with material presented by Ms. McCormick. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post. Please tell us who you are and where you live.]

Attendees included several City Councilpersons: Vice Mayor Bob Becker, Daniel Brown, Nick Della Volpe and former Councilman Barbara Pelot. County Commissioner Finbarr Saunders was present, too.  Also present were several members of the staff of the City’s and the County’s Community Development departments–Madeline Rogero, Director City of Knoxville Community Development; Grant Rosenberg, Director Knox County Neighborhoods and Community Development; Linda Rust, also with Knox County Community Development. Several members of the mental healthcare provider community were present. My apologies if I’ve missed anyone. The format of this meeting was one hour. The first half hour was used for presentation, the second half hour was for conversation with attendees.

Ms. Adams, in her role as moderator, focused this meeting’s topic on mental illness and chronic homelessness. She also mentioned the date and topic of the TYP’s next public conversation, which will take place at the Cansler YMCA on Wednesday, August 25, and will focus on the subject of addiction treatment. She introduced Ms. McCormick and her topic. Ms. McCormick coordinates recovery services at Peninsula. She is also a respected mental health advocate. Ms. Adams described the format of the meeting: Ms. McCormick will speak for one half hour and share a PowerPoint presentation during that time. The following half hour is reserved for discussion. We’ll stick to the topic: mental illness and chronic homelessness, and limit each question and answer in the discussion to three minutes so that everyone who wants to has the opportunity to participate.

Ms. McCormick introduced herself and said that tonight we’re going to talk about mental health services for people in permanent supportive housing. She started off with background about the nature of mental illness. [Note: Much of the following material comes from Ms. McCormick’s PowerPoint presentation and is interspersed with her remarks.]

What is mental illness?

• A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal.
• Mental illnesses cause more disability than any other class of medical illness in America.
• Mental illness is very common and is in no way limited to people who experience homelessness. In Knox County, 106,000 of 389,327 residents (about one in four) have a diagnosable mental illness of some type.
• More than half of these have more than one mental illness.
• Co-occurring mental health and substance abuse disorders are common.
  • 52 percent of people diagnosed with alcohol abuse or dependence have also experienced a mental illness.
  • 59 percent of people with a history of other drug abuse or dependence have experienced a mental illness.
• Mental illness frequently predates substance abuse problems by a period of four to six years. Alcohol or other drugs may be used by people who don’t know they have a mental health problem as a form of self-medication to alleviate the symptoms prior to diagnosis and effective treatment.
• People with serious mental illness die 25 years earlier than the general population. Their increased morbidity and mortality are largely due to treatable medical conditions and inadequate access to medical care.
• Although certain diagnoses do have lower treatment success rates, all mental illnesses respond to treatment, especially if the person participating in treatment accepts the need for change and is actively involved in his or her own recovery.
  • Treatment for mental illness is actually more effective than treatment for cancer, diabetes, and other chronic conditions.
• In a given year, only approximately 1/3 of people in the community with mental illness will receive treatment services.
  • Some people with mental illness suffer from a disorder called anosognosia. People with anosognosia do not recognize that they are ill, and therefore do not seek treatment. Once this challenge is overcome, they too can experience recovery.

Treatment providers

Community Mental Health Agencies

• Cherokee Health Systems
• Helen Ross McNabb Center
• Peninsula- A Division of Parkwest Medical Center

Other Providers

• Lakeshore Mental Health Institute
• Child and Family Tennessee
• Mercy St. Mary’s
• Various private mental health professionals

Adult services

• Crisis services
• Mobile Crisis Unit: Crisis services are provided by MCUs when there is a perception of a crisis by an individual, family member, law enforcement, hospital staff or others. MCUs are frequently actuated by law enforcement officers and are available regardless of ability to pay. Slide 14.
• Crisis Stabilization Unit: CSUs are accessible 24/7 by telephone and/or walk-in services with face-to-face crisis service capabilities including triage, intervention, evaluation/referral for additional services/treatment, and follow-up services. Helen Ross McNabb’s Crisis Stabilization Unit provides assessment, triage, medication management, group and individual therapy, and the opportunity for clients to work with a peer specialist. CSUs are cost effective, offering up to 72 hours of intensive, 24/7 mental health treatment in a less restrictive setting than a psychiatric hospital. Funding is provided partly by the Tennessee Department of Mental Health and partly by TennCare
• Inpatient hospitalization is provided in a physically secure setting in a licensed general hospital (Mercy St. Mary’s); Psychiatric hospital (Peninsula); or state-operated psychiatric hospital (Lakeshore). Inpatient hospitalization offers a full range of diagnostic, educational, and therapeutic services with the capability for emergency life-saving medical and psychiatric interventions. Average stays are three to seven days. Admission into this level of care results from a serious or dangerous condition that requires rapid stabilization of psychiatric symptoms. This service is generally used when 24-hour medical and nursing supervision are required to provide intensive evaluation, medication, symptom stabilization, and intensive brief treatment. It has been discovered that the vast majority of people who are hospitalized don’t need to stay in the hospital for long periods of time. The usual goal is to stabilize in the hospital and then provide ongoing treatment in the community.
• Intensive Outpatient services is more intensive than traditional outpatient services; is designed to achieve short-term stabilization and resolution of immediate problem areas; is offered by a team of professionals which may include a doctor, licensed therapists, nurses, and program specialists; is a time-limited program for people working on similar issues.
• Psychiatric Assessment is a process of gathering information about and from a person within a mental health service for the purpose of making a diagnosis, the assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and often data from specific psychological and lab tests.
• Medication Management is a service that includes psychiatric assessment with recommendations for treatment; medication evaluation and management– prescription and review of therapeutic effects and possible side effects; laboratory services and referral(s) to other specialists; and clinical documentation in an individual’s care record. Most provider agencies offer this service. Sometimes, a person receiving this service will see his or her service provider only four times a year for fifteen minutes at a time. There is a serious emphasis on this service now because it is especially cost effective and is extremely efficacious for many people.
• Therapy is offered by many providers and are especially helpful for people who have developed maladaptive coping mechanisms over long periods of time.
  • In individual therapy the client meets face to face with a therapist to talk about the things that are bothering the client, to help clarify and put problems and issues in perspective.
  • Group therapy is a form of psychotherapy in which a small, carefully selected group of individuals meets regularly with a therapist to assist each individual in emotional growth and personal problem solving.
• PACT (Program of Assertive Community Treatment). Helen Ross McNabb Center has the only PACT in East Tennessee for adults with severe mental illnesses. PACT is designed to help people reduce or eliminate symptoms, function in the community, live independently, and reduce hospitalization. PACT provides intensive, direct care and services 365 days a year, primarily in the home and in the community, which enhances accessibility and the comfort level of clients. There is no time limit on program participation. PACT is very effective for people who are very ill.
• Continuous Treatment Teams. Adult CTT is an intensive outpatient treatment program that is comprehensive in nature. CTT offers case management, medication management, crisis intervention, advocacy and goal-oriented therapy services. CTT clients have on-call crisis services 24 hours a day, seven days a week.
• Case management is a range of services to assist and support persons receiving mental health services to develop skills to gain access to needed medical, behavioral health, and other services/ supports. Case managers assess needs, link to services, train on use of community resources, and monitor overall service delivery. Case management is intensive, relationship based care coordination for people who have ongoing support needs in areas such as housing, employment, social relationships, and community participation.
• Psychiatric rehabilitation is self directed treatment for people who want to be in recovery. It reinforces and emphasizes hope, personal responsibility, self advocacy, support and skills development. It is extremely important that people with mental illness know that they have a voice because many of them have been so beaten down and forced into silence, resignation, and hopelessness. Some people who had been hospitalized twenty times per year or more have completed a program of psychiatric rehabilitation and do not have to be hospitalized any more as a result. Psychiatric rehabilitation promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives. Psychiatric rehabilitation provides independent living and social skills training, psychological support to clients and their families, vocational rehabilitation, social support, and access to leisure activities. Psychiatric rehabilitation services are collaborative, person directed and individualized.
• Transportation is provided to covered services for TennCare enrollees with no other means of transport through contracted transportation vendors, such as ETHRA and CAC. In a crisis, transportation to a psychiatric facility may be provided by a law enforcement officer if the person is deemed to need restraint or a secure vehicle.
• Peer support is run by peers for peers. Peer support promotes recovery through one-on-one peer support sessions or through group interactions. The service may include resource sharing, recovery education, support groups, and training about how to obtain and use services and supports. Peer support is offered at no cost through Helen Ross McNabb’s Friendship House and Peninsula’s Knoxville Wellness Recovery Center. Friendship House has operated in the Fourth and Gill neighborhood for twenty years.

Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. For some people, recovery is the ability to live a fulfilling and productive life. For others, recovery implies the reduction or complete remission of symptoms of their mental illness. Recovery is very much an individually-determined thing. Contrary to what many people believe, recovery from mental illness can be complete and often is. For example, some people with psychiatric disorders like schizophrenia, bipolar disorder, and other severe forms of mental illness have experienced recovery from their mental illness to the point that they have been able to enter challenging and rewarding professional fields such as psychiatry, engineering, the law, and others.

Stigma plays a huge role in the lives of people with mental illness. It interferes with people accessing treatment; has a profoundly negative impact on their self-esteem; shapes public policy, including funding for research, treatments, and services, and for housing, in inappropriate and damaging ways; decreases the  likelihood of a person with mental illness admitting  that he or she has a mental health problem, which interferes with their accessing the treatment they need to recover. Stigma interferes with society’s acceptance of individuals who suffer from brain illnesses through no fault of their own.

Myths. Ms. McCormick discussed myths about mental illness and related them very powerfully to her own story.

The first myth she discussed was this one: There is no hope for people with mental illness. The fact is that there are more treatments, services, and community support systems than ever before, and more are being developed. People with mental illnesses lead active, productive lives. Ms. McCormick disclosed that she is one of them. “I am in recovery from bipolar disorder,  and severe anxiety. I’ve been delusional. I’ve been self destructive. And I’ve been homeless. I was able to get treatment, education, tools and resources that helped me in recovery. I’ve had people around me to help me who helped me.”

The second myth is that people with mental illness are violent and unpredictable. Actually, the vast majority of people with mental health conditions are no more violent than anyone else. People with mental illnesses are much more likely to be the victims of crime than the perpetrators of it. You probably know someone with a mental illness and don’t even realize it.

The third myth is this: I can’t do anything for a person with with mental illness. Ms. McCormick said that you can help, starting with how you act and speak. Don’t focus on people’s disabilities. Instead, create an environment that builds on people’s strengths and promotes understanding. For example:

• Don’t label people or define them by their diagnosis.
• Learn the facts about mental illness and share them with others.
• Treat people with mental illness with respect and dignity.
• Respect the rights of people with mental illness and don’t discriminate against them when it comes to housing, employment, or education.

The fourth myth is that people who develop mental illness can never recover. The fact is that most people with mental illness get better, and many recover completely. There are now approximately a hundred  people at any given time in the hospital at Lakeshore [Note: At its highest capacity, Lakeshore, which used to be called Eastern State Mental Institute, had approximately 2,500 beds.] and another hundred at Peninsula. There are not all that many people in institutions anymore. They’re in the community, everywhere, and many of them are integrated into the community and doing quite well.

Hope! Ms. McCormick emphasized that hope plays a key role in recovery. People who live in permanent supportive housing have a very good shot at recovery because they are living living somewhere safe that provides them with a support network. She said that recovery is almost impossible when you’re stressed out and living on the street.

Ms. Adams opened up the second half of the meeting for questions and comments, asking everyone to stick to the topic and to keep their interactions to three minutes or less. She expressed her willingness to help the conversation stay on track.

Councilman Della Volpe asked how many people with mental illness in the community seek or get treatment? Ms. McCormick said that about a third of them do, and that not all of those who seek and receive treatment have a severe, persistent mental illness–it runs the gamut.

Jerry Askew asked if we have stats that show how important it is for people seeking to recover from mental illness to be in housing as opposed to living on the streets. He said that it seems like it’s more likely that treatment is more effective for people who are in housing. Mike Dunthorn answered that studies show that housing has a tremendous positive effect on the efficacy of treatment and the ability of people to recover. Housing takes a person out of the chaos of the streets and out of survival mode and provides the stability a person needs to focus on the work of recovery.

A woman mentioned that she had seen the night before this meeting a television show on schizophrenia. That show said that the largest mental health facility in the nation is the Los Angeles county jail. 30% of inmates there have some kind of mental illness. Ms. McCormick said that if you want to get definitive information about this for our community that you can contact Ben Harrington at Tennessee Department of Mental Health. Leann Human-Hilliard of Helen Ross McNabb Center said that 18-20% of inmates in the Knox County Jail are on medication for psychiatric disorders, and reiterated that Ben Harrington would know precise statistics.

A man asked if mental illness leads to homelessness, or vice versa? Ms. McCormick’s response essentially was “Yes.” If you are mentally ill, that definitely places you at much greater risk of losing your housing than if you are not mentally ill. Too, being homeless can cause post-traumatic stress disorder, anxiety, depression. The chaos, fear, danger and abuse that goes along with homelessness can trigger mental illness in anyone who is predisposed to it.

A woman asked if people are kicked out of Peninsula when their insurance runs out. Ms. McCormick said that she doesn’t know, but she does know that Peninsula provides Safety Net services. Another woman said that Cherokee Health Systems takes up slack, providing services for those who are indigent. Safety Net was created by the State legislature when TennCare was being downsized. Ms. McCormick contrasted the cost of $853 per day to be hospitalized at Lakeshore versus the cost of $750 per year to provide services in Safety Net.

Councilman Della Volpe said that lots of times people get stabilized on medication, then they quit. He asked why this happens. Ms. McCormick’s response was “Because we’re human beings.” She went on to explain that when people start to feel better they stop taking meds, or they forget to take them, or they start to think that they don’t really need the meds. Anosognosia is a factor too. This is one reason why supportive housing is so important. Case managers and peer specialists on site can recognize these kinds of things when they start to happen and get people back on track before it becomes a real problem.

Joe Minichiello asked for Ms. McCormick’s assessment of the 48 to 2 ratio of clients to case managers proposed at Flenniken Housing. Ms. McCormick said that that ratio sounds about right.

Councilman Bob Becker mentioned that people with mental illness are more likely to be victims of crime than perpetrators. He asked for Ms. McCormick to discuss that in context. Ms. McCormick said that so many of us get our identity from work, where we live, and also from the people we associate with. A person’s identity can get really messed up by being adrift in homelessness. You’re worried all the time. You don’t know who to trust. Many times, other homeless people become your support network. Most predators are just passing through, but still they’re common enough and are a source of constant worry. And of course, when you’re homeless, some things happen to you that are pretty awful. Therapy can help you recover from the damage, but it doesn’t do anything to prevent it happening in the first place.

An attendee asked Ms. McCormick to discuss moving from negative coping mechanisms to positive ones. Ms. McCormick said that people who are homeless often cope by learning to live by manipulation. They have not been taught legitimate skills that they need to live legitimately in society. Also,  the mental health system forces some people to become manipulative so they can get into the hospital—they know they need to get somewhere safe, so they learn how to work the system. Once you move out of homelessness, you’re not just surviving anymore, and you have to learn how to function in a new way. You need to be taught the appropriate skills to do that, and services like therapy, among others, help with that. It takes the right services, hard work, and time, but it’s doable. People do it all the time.

Ron Peabody asked if Peninsula is a committed provider of treatment to residents of permanent supportive housing. Ms. McCormick said that she didn’t know how to answer that question. She said that she is sure Peninsula would provide services to people in permanent supportive housing. Mr. Peabody said that these meetings are supposed to be about providers who are providing services to residents of permanent supportive housing. Ms. McCormick mentioned that Peninsula used to provide a lot of services in rural communities and that their location in Knox County is a mile from the Knox Area Transit busline. Jerry Askew suggested that relevant relationship is the one between the TYP and Peninsula, and that most people aren’t mentally ill who are chronically homeless, although some are. If we can help them get into housing, we know that they’re going to do better. We also know that in absence of housing with good case management support, bad stuff happens. People in housing are far more likely to be treated well. Dr. Osborne with Peninsula said that housing increases effectiveness of the kinds of treatment Peninsula delivers. Sometimes it takes a time, and trial and error, to find the right combination of medications and other treatment, but it’s much better to be working on that with someone who is in housing than with someone who is trying to address mental illness while they’re still living on the street.

Bob Fischer suggested that the 1:24 ratio [the case manager to client ratio proposed for Flenniken Housing] seems like a stretch. 1:10 to 1:12 seems to be the norm elsewhere. Ms. McCormick replied that there are different kinds of case managers. Ms. Human-Hilliard affirmed that, and added that  the definition of case management is very broad. When you talk about onsite case management, a lot of those ratios are very small. Some of the intensive services offered by Helen Ross McNabb have case manager to client ratios closer to 1:10. But McNabb also has programs with ratios that exceed 1:30. It really depends on the level of severity of need.  Mr. Fischer suggested that unless our community makes a commitment to provide these services over the long run, we won’t succeed. A woman in attendance suggested that in fact the  ratios proposed for Flenniken Housing are really good. She went on to point out that a person might have three or four case managers from different programs at one given time working in a collaborative way, and that that is a dynamic thing that is responsive to the needs of the person in treatment.

Madeline Rogero suggested that the purpose of tonight’s conversation is to discuss the array of services available in the community to those seeking treatment for mental health issues. She asked, “If a person needs to be at Peninsula they can go, right?” Ms. McCormick said that yes, of course they could. Ms. Rogero said that that had not been clear in the foregoing discussion. Ms. McCormick went on to say that a person in supportive housing, or any other kind of housing, really, can stay where they live and get services from any of these providers being discussed tonight.  She added that people are not in crisis all the time. Some of these client to case manager ratios are what they are because not everyone is in crisis at the same time.

Ron Peabody said that it is not accurate to believe TennCare will provide for all of these folks. He pointed out that until April 2 of this year, the Safety Net was about to be cut, and was only saved by being re-funded. He asked how the TYP can guarantee that these services will be paid for in an ongoing way. A woman in attendance mentioned that a whole lot of people with mental illness in Knox County will receive services just because they’re here, they’re indigent, and/or they get put in jail. Michael Dunthorn pointed out that helping people gain access to supportive housing does not create more mentally ill people and does not increase the burden on our service delivery systems. In fact, people in housing place much less demand on those systems and make resources go further and serve more people who need them. It’s just much more cost-effective. Grant Rosenberg mentioned that Knox County spends, right now, five million dollars per year for indigent care, and that those are all local dollars, not federal pass-through. He also said that if we can help more homeless people find housing, their use of these dollars will decrease. Right now, he said, it’s the status quo that is not sustainable.  A provider who works at Peninsula said that Peninsula takes TennCare and Medicare recipients. Cherokee Health Systems delivers care to the indigent, and our jails and emergency rooms take the overflow. In Peninsula, we can use resources much more efficiently when we’re treating people who are in housing.

Jessica Bocangel, with The Compassion Coalition’s Circles of Support, said that she has had much conversation with a psychiatrist who constantly underscores the need to for our community to focus not so much on mental illness, but to focus instead on mental health. She posed this question: “Will we we become the kind of community that encourages mental health or will we be one that talks only about our fear of the mentally ill?”

Ms. Adams closed the meeting a few minutes after 7pm. She encouraged anyone with further questions to contact the TYP office.

Next meeting

The next public conversation will be held at the Cansler YMCA from 6-7pm on Wednesday, August 25. The topic will be addiction treatment in the context of the TYP. We’ll publish more information here about that as we get closer to the date of the meeting. We’ll follow the same basic format. First half hour presentation, second half conversation about the subject.

1. Coming up this Wednesday: Public Conversation #4 — Mental healthcare services delivery. The TYP will hold its next public conversation on 6pm Wednesday, July 21 at the Cansler YMCA.

2. Reminder: Neighborhood meeting about Flenniken Housing. The TYP will dialog with residents of the neighborhoods close to the Flenniken School about safety on Thursday, July 29 at the South Knoxville Community Center.

3. In the news: Transport of people who are homeless to Knox County. The TYP’s response.

The TYP will hold its next public conversation at 6pm Wednesday, July 21 at the Cansler YMCA. The topic will be mental healthcare services in the context of permanent supportive housing. Sheryl McCormick, Coordinator, Recovery Training Services at Peninsula, will present for the first half-hour with Q & A to follow.

Ms. McCormick, as a person who has experienced homelessness and who lives a full and active life with a psychiatric disorder, brings a unique and extremely well-informed perspective to this conversation. McCormick says that recovery would not have been possible for her if she’d been warehoused or otherwise segregated. Community integration, with housing built out in the community, is critical for the success of people with mental illness.

We encourage you to attend this important conversation and to invite people you know to attend with you. This is an excellent opportunity to gain a more complete understanding of how mental healthcare services are delivered in our community and why they are such a vital component of our own Ten-Year Plan’s strategy to end chronic homelessness.

2. Reminder: Neighborhood meeting about Flenniken Housing

The TYP will dialog with residents of the neighborhoods close to the Flenniken School about safety on Thursday, July 29 at the South Knoxville Community Center.

The last time we met was on June 21. At that meeting we discussed establishing a regular meeting concerning Flenniken Housing. Attendees agreed that a monthly meeting on Monday* evening would be appropriate, and that the meeting should continue to take place at the South Knoxville Community Center. Attendees also generated a list of potential topics for those meetings. It became apparent at that time that the most significant concerns shared by Flenniken’s neighbors are related to the over-arching issue of safety, and that is what the meeting on the 29^th will be about.

*Please note that this meeting had previously been scheduled for Monday, July 19. It was changed to Thursday, July 29 at the request of a City Councilmember whose schedule did not permit attendance on the previously-scheduled date.

Again, we encourage you to attend this meeting and to invite others to join you. Safety for residents of permanent supportive housing, as well as for their neighbors, is of vital concern no matter where it’s built.

3. In the news: Transport of people who are homeless to Knox County

We spoke this week with reporters for local television stations about the recent news that officials from some counties surrounding ours have been sending people who are homeless to Knox County. We sent them the following information:

• The TYP’s reaction to news that some surrounding counties send people who are homeless who get discharged from jail to Knox County so they can obtain shelter.
  • To keep this in perspective, Knoxville is a mid-sized city situated within an area that’s historically rural. We have all kinds of resources here. That’s true of any city like ours.
  • People come to Knoxville from surrounding counties for a lot of different reasons: healthcare, jobs, educational opportunities, and more.
  • Are people who are homeless from surrounding counties going to come to Knoxville to gain access to services here? Sure. I’d probably want to do the same thing if I had no family, friends and other resources available to me if I fell into homelessness nearby.
  • Contrary to an often-repeated myth, we are not a unique magnet for homeless people from all over the country. Over 60% of the people who experience homelessness in Knox County list an address in Knox County as their last permanent address, with just under 80% having their last permanent address in Knox or one of the counties that surround Knox.
  • Our situation is very similar to most other cities of our size in our part of the country.

• The TYP’s reaction to the Sheriff’s response to learning that KCSO employees were meeting their colleagues from other counties and bringing people discharged from jails to homeless shelters in Knox County.
  • Sheriff Jones was very responsive and acted fast to resolve the situation just as soon as it came to his attention.

The July 9, 2010 edition of the Knoxville News Sentinel ran a front page article titled Ashe against idea for park to be future site for homeless residence. This article contains some elements that are unfortunately misleading. We have spoken to the reporter about our concerns. We want to make it clear that we are not pursuing any development of permanent supportive housing at Lakeshore Park and have no plans to pursue a Low-Income Housing Tax Credit application for Lakeshore in 2011.

2. Reminder: Public Conversation #4

The TYP will hold its next public conversation on 6pm Wednesday, July 21 at the Cansler YMCA. The topic will be mental healthcare services in the context of permanent supportive housing. Sheryl McCormick, Coordinator, Recovery Training Services at Peninsula, will present for the first half-hour with Q & A to follow.

1. Flenniken Housing: Parking variance request withdrawn. Southeastern Housing Foundation, the TYP’s nonprofit real estate development partner and developer of proposed permanent supportive housing at the old Flenniken School, has withdrawn its request for a zoning variance that would have permitted a smaller parking lot than what zoning requires. The project will go forward with a 58-space parking lot.

2. Recap: Compassion Coalition’s Salt & Light Luncheon. On Thursday, June 24, over 150 attendees at this luncheon learned about the Ten-Year Plan and how the faith-based community is engaging with its movement to help end chronic homelessness.

3. Recap: TYP Advisory Board Meeting. The TYP’s AB held its quarterly meeting on Friday, June 25, five days prior to the beginning of a new fiscal year. There was an update on housing placement numbers for the past two years (302 formerly chronically homeless people remain in housing), a discussion of next year’s goals, and a presentation by and dialog with Stephanie Matheny, a Knoxville resident with over a decade of experience developing affordable housing, including permanent supportive housing, in Seattle.

4. Preview: Public Conversation #4. The TYP will hold its next public conversation on 6pm Wednesday, July 21 at the Cansler YMCA.

Southeastern Housing Foundation, the TYP’s nonprofit real estate development partner and developer of proposed permanent supportive housing at the old Flenniken School, has withdrawn its request for a zoning variance that would have permitted a smaller parking lot than what zoning requires. The project will go forward with a 58-space parking lot.

Here’s the press release, dated June 29, 2010:

The Office of the Ten-Year Plan to End Chronic Homelessness announced today that Southeastern Housing Foundation, a non-profit affordable housing development organization, is withdrawing a request for a zoning variance for the old Flenniken School project following a public meeting with area residents. The public meeting was held June 21 at the South Knoxville Recreation Center. Residents clearly felt that there were parking issues with other developments in the area.

“We wanted to build fewer parking places because we believe they won’t be used and that the money to build them could be better spent. We also were concerned about unnecessary concrete which could be green space. However, the number of spaces is clearly an issue with the people who live nearby,” said David Arning of Southeastern Housing Foundation. “District Councilman Nick Pavlis also expressed his concerns. Therefore we are withdrawing the request for variance and will build all 58 parking places required by Codes.”

“We are committed to communicating more with the entire community and to listening to what they say,” said Jon Lawler, Director of the Ten-Year Plan. “If we can make adjustments based on what we hear, we will. That’s an important part of the process.”

The TYP has also committed to a monthly meeting with residents of the neighborhood close to Flenniken. The next one is scheduled for Thursday, July 29 at 6pm at the South Knoxville Community Center.

2. Recap: Compassion Coalition’s Salt & Light Luncheon

On Thursday, June 24, approximately 200 attendees at this luncheon learned about the Ten-Year Plan and how the faith-based community is engaging with its movement to help end chronic homelessness. Grant Standefer, Compassion Coalition’s Executive Director, pointed to some of the successes of the TYP.

• Knox County CAC’s Homeward Bound housed 255 homeless persons in 2009, 80% (202) of whom have remained in housing after one year. 99 of these were chronically homeless, and of those 77% (76) remain in housing after one year.
• Volunteer Ministry Center has housed over 250 previously chronically homeless in permanent supportive housing since July 1, 2007. 91.2% remain in housing.
• Prevention is a focus of the TYP. Four CAC case managers have worked with 263 residents of KCDC public housing units. None of these residents have been to the streets. Prior to CAC’s efforts in this area, an average of 67 per year were being evicted to the streets.

Jon Lawler described the TYP, the fact that it seeks to end homelessness by providing otherwise inaccessible resources to people who are chronically homeless (disabled individuals who have been homeless for a long time) mostly through the means of permanent supportive housing, and that the end goal is to empower people to integrate into the community. He underscored that this approach is demonstrated to be effective by research and also by our own local experience. He mentioned that the TYP is aligned with the federal government’s approach to the issue of homelessness.

Lawler encouraged members of the faith-based community to focus their attention on efforts that contribute to ending homelessness and helping formerly-homeless people to form healthy relationships (Circles of Support), to support those who are doing the work, and to attend public meetings and advocate for housing.

Jessica Bocángel shared three stories of Circles of Support teams. Circles of Support is a mentoring program sponsored by The Compassion Coalition. It pairs one resident of permanent supportive housing, a “neighbor,” with a team of five “mentors” who meet with their neighbor on a regular basis for an agreed-upon period to build friendships. It’s not always easy, but the program is successful. Circles of Support mentor teams are increasing in number, and are helping people who had spent years living on the streets to build healthy relationships and experience “wholeness, reconciliation, and reintegration into the community.”

Standefer encouraged the faith community to respond to the TYP by keeping communication respectful, honest, and open. He encouraged patience as the TYP seeks to implement a “complex, complicated process.” He also offered a handout with several specific ways to for faith communities to connect and get involved in the work.

In addition, Stephanie Matheny announced that she is working to form a pro-TYP group called Citizens for the Ten-Year Plan. They plan to be the citizen voice in support of the plan, and against the referenda if they end up on the ballot. The group was founded by Bill Snyder, Sheryl McCormick, Ray Abbas, and Stephanie Matheny.

Matheny is in the process of collecting a list of names of people who support the TYP.  She plans to put the list on a website — only names and zip codes, not their other information. Citizens for the Ten-Year Plan will also use the emails to form a listserve to announce meetings, ask people to write to council members, etc. She said, “This is not a “petition” – it is not directly related to the referenda and has no legal significance. We just want to be able to demonstrate that there are many of us who would like to see the TYP succeed.”

Ms. Matheny got about 60 signatures at the Compassion Coalition event (as of July 6, 115 people have signed up) and she would like to get several hundred before the website goes live.

3. Recap: TYP Advisory Board Meeting

The TYP’s AB held its quarterly meeting on Friday, June 25, five days prior to the beginning of Year 5 of the TYP’s implementation. There was an update on housing placement numbers for the past two years (over 300 formerly chronically homeless people remain in housing), a discussion of next year’s goals, and a presentation by and dialog with Stephanie Matheny, a Knoxville resident with over a decade of experience developing affordable housing, including permanent supportive housing, in Seattle.

Three over-arching goals for Year 5 were discussed.

1. All stakeholders in the plan will be effectively engaged regarding the plan’s ongoing implementation.
2. The original version of the TYP will be updated to reflect the specific systemic improvements resulting from the TYP’s work with Brad Greene (the conceptual design will be developed into a specific working document via the involvement of all the stakeholders).
3. Increase the housing options available to the entire homeless population.

There was a brief discussion of how these goals would be shaped with Advisory Board input (see item 1 above) and of other stakeholders who should be invited into the discussion. Advisory Board members pointed out that this goes beyond an “update” to the TYP. We’re at a natural halfway point, a great deal of progress has been made, especially in the area of interagency communication and cooperation, and this is a good time to open up the discussion to a lot of input from the public. There was also strong agreement among Advisory Board members about their desire to increase the level of discussion, reflection, and input from the Advisory Board.

The Advisory Board requested a weekly update from the TYP office. (An update will also be prepared for City Council, County Commission, and for the Homeless Coalition. It will be published on the Ten-Year Plan’s website, too.)

Stephanie Matheny addressed the Advisory Board of her eleven years’ experience developing affordable housing, most of it serving the homeless, in and around Seattle/King County, Washington.

• King County’s efforts to address the need for supportive housing began in 1992, when their health department realized that the same people were cycling over and over through detox.
• There was housing available at the time, but all of it required sobriety and was not effective, and they came to realize that they could house people and at the same time reduce public cost and public inebriation.
• When Matheny’s group began planning the Wintonia Apartments in King County, they held dozens of public meetings which were invariably painful and difficult.
• They made changes to their plan along the way, with public input, began operation in 1994, and has achieved great acceptance by its neighbors, which include a private school.
• Residents still drink, but far less than when they were homeless, and costs to the public have been reduced significantly.
• Case management to client ratio was approximately 1:25 in the beginning.
• Seattle has voted a housing levy to make more local funding available for affordable housing development.
• Seattle developed and still uses a detailed public notification process for affordable housing developers.

Three top lessons from Seattle about supportive housing development:

1. Expect opposition to any proposed supportive housing development. It will be significant at the outset, and some folks will never come around.
2. Mistakes will happen. The development process is extremely difficult.
3. You can’t give up just because people in the community are not happy about it.

Matheny also offered these suggestions:

• Help people understand that there’s a big difference between site control and a finalized purchase. Site control does not equal “done deal.” Contingencies are wide open before purchase.
• Do as much due diligence as possible before announcing site control—there is no sense in arousing concern before developer knows he’s interested in moving forward with the site.
• Outreach to the community must happen before closing the purchase, but not before obtaining site control.
• Tout the successes of the TYP. The interagency coordination achieved is a huge success.
• Try to figure out a way to de-stigmatize residents of supportive housing. They are not homeless anymore, after all.

There was some interaction between Advisory Board members and Ms. Matheny, and the next two Advisory Board quarterly meeting dates were announced.

4. Preview: Public Conversation #4

The TYP will hold its next public conversation at  6pm Wednesday, July 21 at the Cansler YMCA. The topic will be mental healthcare services in the context of permanent supportive housing. Sheryl McCormick, Coordinator, Recovery Training Services at Peninsula, will present for the first half-hour with Q & A to follow.

We’re thinking ahead about potential topics for these public conversations, which have been quite well-attended. We are considering addressing the subject of substance addiction treatment at the next one, which will happen in August. As always, we value your input on this. Please let us know what you think.

The TYP held its third Public Conversation tonight, Wednesday, June 23, 2010 at the Deane Hill Recreation Center about the origins of our own Knoxville and Knox County Ten-Year Plan to End Chronic Homelessness (TYP). Dr. Bill Lyons, the City of Knoxville’s Senior Director of Policy & Communication, acted as moderator. Dr. Roger Noose, Professor (Emeritus) UT College of Social Work; Linda Rust, Knox County Community Development; and Mike Dunthorn, TYP Project Manager, delivered a presentation about the process by which the TYP was developed in our community, the forces that drove its development, and its rationale. The meeting was quite well attended (probably just over fifty folks came out), and the conversation, once again, was respectful and quite informative.

I’ve transcribed my notes from the conversation below, edited only for clarity.

Notes

[These are my notes. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post.]

Attendees included several City Councilpersons: Vice Mayor Bob Becker, Marilyn Roddy, Brenda Palmer, Nick Della Volpe and former Councilman Barbara Pelot. County Commissioners Amy Broyles, Finbarr Saunders and Ed Shouse were in attendance. Also in attendance were several members of the staff of the City’s and the County’s Community Development department–Madeline Rogero (Director City of Knoxville Community Development)  and Grant Rosenberg (Director Knox County Neighborhoods and Community Development). My apologies if I’ve missed anyone.The format of this meeting was one hour. The first half hour was used for presentation, the second half hour was for conversation with attendees. The meeting ran longer than one hour; I think it ended at about 7:15 or 7:20pm, but I’m not sure.

Dr. Lyons, in his role as moderator, focused this meeting’s topic on the formation of the TYP, the thinking behind it, the process of developing it, and its logic and goals. He also mentioned that this meeting is the third in a series to fully explain and dialog about the components and strategies connected with our community’s efforts to end chronic homelessness. Dr. Lyons mentioned that the presentation half of the conversation would focus on the long process we went through to develop the Knoxville/Knox County response to homelessness.

Dr. Nooe led off with background. To understand our TYP, you have to look back to the 1980s. There was at that time a growing awareness that homelessness was increasing across the country. In Knoxville at that time there were six shelters, and lots of groups who were providing food and other resources to homeless people. The causes of homelessness were beginning to be better understood, and included a national trend towards significant reductions in low-income housing that was partly brought about by urban renewal; deinstitutionalization, a movement to close or greatly reduce mental institutions in favor of residence and treatment in the community; increasing substance abuse; a job market whose competitiveness was increasingly growing; rising domestic violence, and other factors.

In 1986, Mayor Kyle Testerman and County Executive Dwight Kessel appointed a task force to study homelessness. The first biennial study happened that year, and showed 1000 homeless persons in any given month. By 2006, that number had jumped to 1900 homeless persons in any given month. This trend made it ever more clear that we were losing ground. Several issues during this period became much more obvious. (1) Service delivery was extremely fragmented. Agencies did not communicate with each other, nor did they coordinate service delivery. This made our “system” extremely inefficient. (2) Most services were were geared towards increasing the comfort of people who were still living in the streets. Well-intentioned groups offering these kinds of palliative services were mostly concerned with things like delivering blankets, soup, clean socks, restroom facilities.

In 1996, a group came together with the intention of developing a plan to address these issues, but it never generated much momentum and fell through. But in 2003, the United States Interagency Council on Homelessness (USICH) came onto the scene nationally, and in 2004 Knoxville Mayor Bill Haslam and Knox County Mayor Mike Ragsdale appointed a homelessness task force with 17 members and four staff members. This Task Force kicked off our TYP. The Task Force developed four working groups: (1) Housing, (2) Mental Health/Social Services, (3) Employment, and (4) Community Concerns.

Mike Dunthorn discussed the reformation of the mission of USICH under the leadership of Philip Mangano. Dunthorn emphasized the “interagency” component of USICH, which really did focus on bringing together different agencies to tackle the issues around homelessness using research and best practices. It began to become clear it was especially important to begin doing things differently regarding chronic homelessness, and Mangano embarked with USICH upon a mission to promote ten-year plans nationwide. More than 200 communities joined this movement.

Research was starting to suggest that the continuum of care model did not work very well for the chronically homeless population because it essentially asked them to attain sufficient stability to succeed in housing while still living on the streets. [Note: people who are chronically homeless are defined by HUD as unaccompanied disabled adults who have been homeless for at least a year or who have experienced four episodes of homelessness in the past three years. Research demonstrates that although they may make up only 10-15% of the homeless population, they consume about 50% of all the resources communities expend on all homeless persons.] Research was also beginning to demonstrate that housing first works very well with the chronically homeless population, and people were beginning to see housing alone was giving people who had been homeless for long periods of time the kind of stability that leads to positive life change and success. We were seeing good things happening in New York City, Seattle, and other cities, and people here started saying, “Let’s focus on the chronically homeless population, and do something different, because what we’ve done up to now isn’t working.”

Dr. Nooe mentioned at this point that housing is very important, but it’s not all there is to the TYP. He said that he gets very passionate about discharge of homeless people from jail, hospitals, or mental institutions to the streets. There should at least be some kind of coordination between a shelter and a discharging institution. And our TYP also recognized the importance of coordinating services. A homeless person doesn’t need five different case managers—there should just be one. And let’s use technology more effectively. We should also seek permanent solutions to homelessness instead of doing all of this recycling of people through the jails and emergency service providers. And get our churches involved in this solution, and work hard to prevent homelessness from occurring in the first place. Those things are all reflected in our TYP, which is not just about housing.

Linda Rust spoke to the process of developing the TYP. It started in September 2004 with the two mayors doing the Walk the Walk/Talk the Talk event, in which they got to interact with people in shelters and camps. This event had a profound impact on Mayors Haslam and Ragsdale, and the Homeless Coalition, which was forwarding the development of the TYP, wanted to take advantage of this “bigger leadership” represented by the City’s and County’s executives.

Working Groups started later that fall, and Ms. Rust was in the Community Concerns Working Group, which included representatives from the Council of Involved Neighborhoods (COIN), Center for Neighborhood Development (CND), 4^th & Gill Neighborhood Association, Fort Sanders, Knox Area Transit, Knoxville Police Department, and several other organizations. The group discussed  gaps, problem areas, and grappled with the question, “Why are we failing in re: homelessness?”

The Community Concerns working group recognized that, in the past, we had measured success by the number of beds in shelters, the number of meals served, but that we were not helping in a permanent way. They examined and discussed: the impact of homelessness on Knoxville’s downtown; methods for assessing the true cost of homelessness (taking into account more than just the cost of shelter beds, feeding programs, and other services operated specifically for the homeless population); better tracking of numbers of homeless people via improved utilization of the Homeless Management Information System database; the perception that the neighborhoods closest to downtown carry more of the burden associated with the issue of homelessness than they should; the issue of integration into the community; the fact that homelessness is really a community problem that crosses geographic barriers (noting the large number of camps distributed throughout Knox County). The Community Concerns working group also recognized that housing first and permanent supportive housing needed to be a priority in the emerging TYP.

This group also discussed ways to engage neighborhoods, and the Center for Neighborhood Development appeared poised to take the lead on that issue when it went out of existence in 2006.

The Community Concerns working group looked at several different communities, including Louisville KY, Chattanooga, and Maricopa County AZ, and how they were developing their own approaches to homelessness.

Members of all of the working groups recommended that both mayors (City and County) would take responsibility for and ownership of the TYP. An Advisory Board would meet quarterly, and the TYP would need a director, someone who would wake up every day thinking about the implementation of the plan. The Plan itself was always discussed as a living document that would evolve during the course of implementation.

Mike Dunthorn mentioned that there was a great deal of discussion about ownership of the plan. It was super-important to everyone involved in developing the plan that it not just gather dust on a shelf somewhere.

Dunthorn spoke to the TYP’s emphasis on prevention of homelessness. Knox County Community Action Committee (CAC) operates a prevention program in four KCDC properties. They provide case managers there who have reduced evictions into homelessness from an average of 67 per year to zero evictions into homelessness during the first 18 months of the CAC program’s operation. Prevention works, and we know it. Properly-resourced case management works, and we know it.

Coordination is also hugely important. Prior to implementation of the TYP, coordination between agencies was not very good. Now, it’s quite good and getting better all the time, and the change we see in our effectiveness as a community is profound. Coordination was something we developed in our plan and that is one of its main pillars.

Bill Lyons mentioned that some have said that there wasn’t much knowledge of, or community engagement in, the formation of the TYP. He pointed to copies of news stories from the time the TYP’s development process was getting underway, and acknowledged that now that the TYP’s implementation is touching neighborhoods and becoming more visible, people are learning more about it and getting more involved with it. Some of that involvement is critical of the TYP, of course, but even that is good. We need the hard questions. But notwithstanding all that, this plan was not developed in a vacuum.

Dr. Lyons opened the meeting up for questions and comments, asking that participants stick to the broad topic being discussed tonight.

An attendee asked how many homeless people have been housed? Mike Dunthorn responded that 287 people who used to be chronically homeless have been placed in permanent supportive housing in existing apartment units.

Someone then asked for the total number of homeless people in Knox County. Dr. Nooe responded. That’s a hard question to answer because the homeless population is very changeable. The number you’re asking about is never a static number because the people you’re counting don’t have addresses and they move around from place to place a lot. In the past we relied on statistical analysis of estimates based on data collection methods that were at the time the best we had. For example, in February 1986 it was estimated that the number of homeless in Knox County that month was around a thousand. Now, we estimate that between 7000 and 8000 people will experience homelessness in Knox County in one year. Most of those people will be homeless for less than six months, and that’s a good thing. People who are chronically homeless face a very different reality because the issues that have led to their homelessness are so profoundly difficult to address while they’re still living on the streets. It’s very hard to count homeless people and communities always struggle to do it, but our biennial study is really very good compared to other communities’ studies of the same issue. Dr. Nooe also related that back in 1992, a group of people connected with Whittle Communications had asked Dr. Nooe to locate some folks in the community who had escaped longterm homelessness. At that time, Dr. Nooe could only located five people in Knox who fit that description. He pointed out that now we’re placing people in housing in huge numbers [the average rate in Knox County is over 8 per month with one-year retention rates of better than 90%, which is better than the national average].

Jessica Bocángel asked the presenters to discuss what it means to not discharge people to the streets and into homelessness. She also asked how churches used to be engaged, and how they’re being engaged now. Mike Dunthorn responded that discharge to the streets is tough. Funding for hospitals, mental healthcare facilities, jails, etc., is beyond our immediate control, and those organizations serve other people besides just the homeless. They’re not equipped to get people into housing. We are working with them to develop better protocols. You start with simple solutions, like making sure there’s interaction between the discharging organization and the local shelter, so the shelter folks at least know that someone’s coming their way and can anticipate their needs. But it will require changes at the state and federal levels to really improve this problem significantly. The faith community has always been engaged with the issue of homelessness, largely focused on providing for the needs of people who are still homeless. The Compassion Coalition’s Circles of Support, which is a mentoring program specifically for people who live in permanent supportive housing, is a groundbreaking program that seeks to engage the faith based community in a different way, one that leverages the ability and mission of that community to provide healthy friendships so that people who’ve left the streets can more easily rebuild their lives where they live.

Joe Minichiello asked why there is no “cap” on the number of chronically homeless people served in our community. He said that according to Dr. Nooe’s research, 45% of the homeless in Knox County aren’t from here. Why wasn’t that addressed in the plan? Mike Dunthorn asked attendees to raise their hands if they were born here. He said “That’s the issue.” He went on to say that Dr. Nooe’s survey asks “Where were you born?” whereas the Homeless Management Information System database asks “What is the zip code of your last permanent residence?” In our community, over 60% of respondents list a 379 zip, with just under 80% coming from the counties that surround Knox. Dunthorn said that every one of his colleagues around the country gets asked the same question: “Why does our community attract all these homeless people? We’re the destination of choice for them from all over the country.” and that the situation is probably very similar everywhere else. If we’re all creating plans to effectively address the issue of homelessness, we’re all going to be attracting people to our communities about equally.

Brandon, a resident of the neighborhood surrounding the Cox Street permanent supportive housing development built and operated by Helen Ross McNabb Center, raised the issue of security, asking “What do you do with repeat offenders?” He said that he and his neighbors have been dealing with this at Cox Street since October 2009. He went on to say that he realizes that these kinds of facilities are going to be owned and operated by private entities, but who enforces accountability? Mike Dunthorn responded that it is important to recognize that people who are homeless are in the community already. We’re aware of this issue, and are taking steps to see that it’s resolved. In fact, you contacted the TYP to seek resolution and we got on it right away. That wouldn’t have been an available option before the TYP existed. The issue is very important to us, and we are working hard to resolve it. Brandon asked “What is being done about illegal drug use in the neighborhood?” Dunthorn responded that first of all the lease is enforced. That’s the side of the equation controlled by providers of permanent supportive housing. If a person is using illegal drugs on the property, they’re subject to immediate eviction, not to mention arrest. Engaging in violent or threatening behavior will also result in rapid eviction. However, it is important to note that the whole purpose of the TYP is to end homelessness, and that means working very hard with people who need a lot of help. You don’t just want to be kicking them out of their housing the first time they mess up–that would defeat the purpose. Case managers and other staff will be onsite, and they will work with residents to prevent eviction if possible.  If they get evicted, will they just get dumped out in the neighborhood, evicted to the street? No. The case manager would work very hard to place that client in a more appropriate housing setting, perhaps one with more supervision if that’s appropriate.

[Note: TYP director Jon Lawler engaged this situation as soon as he heard about it and offers this account.]

At the South Knoxville Meeting on Monday (6/21/10) and at the Deane Hill Community Center Meeting on Wednesday (6/23/10) a gentleman named Brandon made repeated references to Helen Ross McNabb’s mismanagement of its Cox Street Development.  This issue came to my attention on Monday afternoon when Brandon called my office.  I agreed with Brandon that his concerns were very valid, and I encouraged him to speak with Jana Morgan at Helen Ross McNabb.  I also asked him to call me back on Tuesday (6/22/10) by 2:00 p.m. to give me an update on his conversation with Helen Ross McNabb.

I did not hear from Brandon on Tuesday.  On Wednesday morning I called Andy Black (CEO of Helen Ross McNabb) to inquire about this issue and to determine what action had been taken.  He was unaware of the problem but told me that he would follow up and call me back.

Andy Black immediately called me back to let me know that Brandon had spoken with Jana Morgan on Tuesday afternoon.  Jana had been on vacation on Monday, so she was unable to return Brandon’s call until Tuesday.  Andy communicated to me that while Jana was on vacation the resident manager quit.  This left no nighttime presence at the facility.  Jana communicated to Brandon that Helen Ross McNabb was giving this issue its immediate attention, and Jana also communicated to Brandon that Helen Ross McNabb would schedule a neighborhood meeting to address its current and future methodology for responding to the neighborhood’s concerns.

Brandon knew all of this before he attended the meeting on Wednesday.  In fact, when I spoke to him after the meeting, he expressed his satisfaction at Helen Ross McNabb’s response and their plan for moving forward.  I am not sure why he chose to speak on Wednesday night as if Helen Ross McNabb had been unresponsive.

It should be noted that Helen Ross McNabb has been operating permanent supportive housing in Knoxville as long or longer than anyone else (Child and Family has also been operating PSH for a long time).  Helen Ross McNabb’s model is different than the model that has been proposed at Minvilla and Flenniken.  The Cox Street (15 units plus a resident manager unit) development has a case manager that visits during the day, and a resident manager that is on call during the night.  Cox Street is two buildings, and the main entrance is not monitored by a full-time staff person.  This model has worked well for McNabb in the past, and I am certain that it will work well at Cox Street.

Ron Peabody asked for the total number of homeless persons in the USA in the year 2000. Dr. Nooe responded that he could look that up, but didn’t know it off the top of his head. Suffice it to say that the numbers today are better than they were in 2000. Mr. Peabody said that our “best numbers” were between 1,200,000 and 1,500,000 in 2000, and that President Obama’s new homelessness plan which has just been released stated that there had been a 10% reduction in chronic homelessness in the last ten year, and that that doesn’t sound like success. Dr. Nooe responded that the results vary quite a bit from city to city, and that a 10% reduction would seem like a very good start. Mike Dunthorn held up a copy of the new homelessness plan Mr. Peabody had referenced, Opening Doors Federal Strategic Plan to Prevent and End Homelessness, and corrected Mr. Peabody’s figures by citing this from page 17: “After declining 30% between 2005 and 2007, the number of persons who experienced chronic homelessness remained essentially the same in 2008, but dropped 11% in 2009.” Dunthorn added, “I’d call that successful.”

Scott Smith said that he now understands permanent supportive housing and how it’s necessary to solve this problem, but wondered why sobriety is not a condition of the lease. Linda Rust responded that based on her experience working at Helen Ross McNabb Center, when a case manager encounters a client, the case manager has to meet that client on the level of the client, and clients are not homogenous–they are in all different kinds of places. It’s the case manager’s responsibility to determine needs and find resources to help the client address those needs. To make sobriety a condition of the lease would be very counterproductive for a lot of people, because they would perceive that condition as coercive. Research demonstrates that clients are more likely to get services if they make a choice to do it, and don’t feel coerced. The stability provided by housing is therapeutic in and of itself. It provides a level of peace that helps residents be in a better place to get the services they need to help them confront their issues. Scott Smith replied that at Cox Street, the case manager quit, so surely it would be better to have addressed sobriety in the lease. Bill Lyons said that we have to make sure case managers are present. We must ensure that people living in permanent supportive housing don’t do harm to residents of the surrounding neighborhoods. We need to strengthen all of the functional relationships so that communication between all the constituents is really good. A woman who lives near the Cox Street property said that the neighbors do not have anyone that they can call. Bill Lyons responded that we are aware of this situation, and that we are taking steps to ensure that proper relationships are established and maintained. Dr. Nooe suggested that neighbors contact Andy Black at Helen Ross McNabb Center.

Dave Gartner asked for the name of the Council of Involved Neighborhoods rep in the Community Concerns working group. Linda Rust said that they were Whitney Stanley and Polly Doka.

Brandon said that a Helen Ross McNabb staff person had told him that there is no requirement that they have 24/7 awake staff on site at Cox Street. He said there should be such staff anyway. Linda Rust said that that’s why she was on the phone to Helen Ross McNabb the moment she heard Brandon’s story. Nobody’s happy about the kind of situation he described and everyone involved wants to find out what’s going on get it resolved as soon as possible.

Dave Gartner said that there is no enforcement mechanism in place to ensure that operators of permanent supportive housing do things to an agreed-upon standard. Mike Dunthorn pointed out that while there’s no specific enforcement mechanism, any operator who does poor work puts his or her organization at risk of loss of funds. It’s not like we’re completely without leverage in a situation like what’s being described here. Whatever’s going on, we’ll find out about it and make sure it gets addressed.

A gentleman asked who bears the cost burden of permanent supportive housing residents. Linda Rust replied that many qualify for Social Security disability, which is a federal program, and that people in permanent supportive housing have to pay some portion of their housing expenses. She gave the examples of group homes, permanent supportive housing–you qualify for those kinds of housing because of your disability. Dr. Lyons mentioned that some expense is borne locally, too. Dr. Nooe said that we’ve got to solve this problem, and that we can. He discussed a group that meets every other Tuesday to address the most challenging of our community’s chronically homeless individuals. This meeting is about assigning responsibility, and it’s one of the best things we’re doing to coordinate our efforts and take responsibility for individuals who are out on the streets. He pointed out that not everyone is capable of living in the community, and that we will always need to screen people carefully and help them gain access to appropriate housing.

Next meeting

The next public conversation will be held at the Cansler YMCA from 6-7pm on Wednesday, July 21. The topic will be mental healthcare delivery in the context of the TYP. We’ll publish more information here about that as we get closer to the date of the meeting. We’ll follow the same basic format. First half hour presentation, second half conversation about the subject.