Programs

Infusing high-quality clinical care and consultations is fundamental to HFH’s service delivery model. Given the complexity of the physical and behavioral health conditions many homeless people face, including clinicians on the team to help support our clients, provide services, and consult with our ICMS providers has greatly increased the effectiveness and reach of our work.

The Health Services-operated Star Clinic, located in the heart of Skid Row, is the hub of our clinical services. The clinic specializes in serving patients with complex physical and behavioral health issues who suffer high rates of morbidity. The clinic also provides easy access to medical care for HFH clients residing in nearby interim and permanent housing projects.

Enriched Residential Care (ERC) provides housing options for individuals being discharged from an inpatient hospital setting, or to people living in other housing or in unsheltered settings, and who need care and supervision on an ongoing basis.

• Types of Housing
• Licensed Adult Residential Facilities (ARF)* – ages 18-59
• Licensed Residential Care Facilities for the Elderly (RCFE) *- ages 60 and up
• Skilled Nursing Facilities
  • * also known as Board and Care

ERC Services

• Three nutritious meals per day with snacks
• Case management geared toward assisting the transition to a residential care facility, developing life skills, and linkages to a primary care home, mental health and substance use disorder services
• Transportation and linkages to transportation services to attend appointments, etc.
• Assistance with activities of daily living, medication administration and adherence, and other care and supervision
• Groups, activities, socialization and other supportive services
• Assistance with building support system and coping skills for clients with behavior issues

ERC Data

• Placed approximately 1,000 new clients into ARF, RCFE, or skilled nursing facilities (2016)
• Provided payment to ARF and RCFE operators serving over 800 Department of Mental Health clients using FHSP (2018)

A key element of Housing for Health’s success is the Flexible Housing Spending Pool (FHSP), which was created in 2014 and is operated in partnership with Brilliant Corners. FHSP is a flexible financial tool that HFH uses to supply a range of housing options for program participants based on their needs, and to facilitate transitions between levels of care in order to adapt to people’s changing needs and preferences.

FHSP maximizes flexibility, allowing it to scale for participants in multiple care settings, and all in alignment with Los Angeles County’s Coordinated Entry System. Housing for Health uses the FHSP to support interim housing sites, enriched residential care (ERC) facilities, project-based permanent supportive housing, and tenant-based permanent supportive housing. As the administrator of the FHSP, Brilliant Corners enters into contracts and agreements at the direction of Health Services HFH to secure these resources and negotiate rates, make payments, and maintain working relationships with property and facility owners and providers. For permanent supportive housing participants, Brilliant Corners engages with landlords to secure units and negotiate individual participant leases, issues rental subsidy payments directly to landlords, coordinates with intensive case management providers (ICMS), and provides tenancy and other supportive services.

Interim Housing provides people experiencing homelessness (PEH) with a safe indoor environment to sleep, receive services, and to be assessed and matched to permanent housing resources. HFH specializes in providing interim housing for people with higher acuity needs and administers over 2,800 interim housing beds that provide recuperative care and stabilization housing services.

• Recuperative Care is typically for individuals exiting institutions such as hospitals or custody settings and are recovering from an acute illness, injury, or have a condition(s) that would be exacerbated by continuously living on the street or in a typical shelter setting.
• Stabilization Housing is typically for individuals experiencing homeless and who have complex health, behavioral health, or Substance Use Disorder (SUD) conditions.

Interim Housing Services

• Clean and comfortable sleeping environment
• Three nutritious meals daily
• Case management
• Linkage to health, mental health, and substance use disorder services
• Assistance with life skills
• Daily groups and activities
• Linkage to income and public benefits advocacy
• Assistance with obtaining required documents and system navigation to secure permanent supportive housing
• Transportation and/or linkages to ongoing transportation services
• On-site medical and mental health oversight

Housing for Health’s Permanent Supportive Housing (PSH) efforts include both Intensive Case Management Services (ICMS) and rental assistance and tenancy support services through the Flexible Housing Subsidy Pool, administered in partnership with Brilliant Corners.

PSH Services

• Outreach and engagement
• Housing navigation including housing search and assistance with rental subsidy and lease applications and appointments
• Move in assistance including deposits, utilities, furniture, etc.
• Intensive case management services (ICMS) with ongoing monitoring and follow up
• Linkage to health, mental health, and substance use disorder services (may be provided onsite in project based housing)
• Income and benefits advocacy
• Assistance with life skills, job skills, and educational and vocational opportunities
• Crisis intervention
• Housing retention and eviction prevention services

HFH’s permanent housing program also has special projects and partnerships to support people in permanent housing, including In Home Care Giving supports for people who are waiting for In Home Supportive Services approval or who cannot access this service to remain stably housed, Emergency Financial Assistance for people living with HIV/AIDS, and Assisted Living Waiver and Home and Community Based Waiver linkage.

PSH Accomplishments

• Permanently housed over 14,000 people since 2012
• Provided ICMS to an additional 2,000 clients who were already housed in projects with insufficient services
• 92% housing retention rate after 12 months

Multidisciplinary Street-Based Engagement Teams (MDTs) provide outreach and engagement to connect homeless individuals to housing and supportive services by regularly engaging, assisting and developing trusting relationships over time. The MDTs are the clinical arm of a larger countywide coordinated system of outreach that is organized by region in partnership with LAHSA, DMH, and regional service providers.

MDT Services

• Referral, warm handoff, and transportation to interim housing
• Case management
• Support with reunification with family and social support systems, whenever possible
• Linkage to health, mental health and substance use disorder services
• Linkage to income and public benefits advocacy services
• Assistance with retrieving needed documents and navigating systems to secure permanent housing

MDT Team Members

• Health professional
• Mental health professional
• Substance use professional
• Case manager
• Person with lived experience

MDT Data for 2019-20

• 62 MDT teams
• 22,584 clients contacted
• 11,841 served or referred
• 1001 placed in interim housing
• 716 placed in permanent housing
• 217,705 total services provided