We don’t need random acts of kindness.We don t need random acts of kindness.We need deliberate acts of compassion.

- Mark HorvathMark Horvath

Meet “Homeless” Myron

• 61 years old veteran

• 30 years of homelessnesso e ess ess

• Engagement challengesg g g

• Addictions

• Lack of self-care

There were a million reasons NOT to house Myron.

As a community we committedAs a community, we committed to do “WHATEVER IT TAKES”

to bring him home.

Meet “Housed” Myron• Permanently housed

• Demonstrating self-care

• 2 months sober

Acti el engaged ith• Actively engaged with VA

• Reengaging with family members

Housewarming CelebrationHousewarming Celebration

What Systems Changed?

• Navigation – a new approach to g ppoutreach

• Outreach teams collaborated• Outreach teams collaborated • Extensive community engagement• VAMC Case management• HUD VASH expedited process• HUD VASH expedited process

How did we do it?

Project OverviewProject Overview

• Goal: To identify and house 50 of the most medically vulnerable people experiencing street homelessness in p gMaricopa County.

• Planning began August 3, 2009.g g g• Implementation began April 19, 2010.

Project H3 Committees

• Core Vision Team (4)• Leadership Team (10)• Subcommittees (25)( )

– Housing– Support Services– Survey Week LogisticsSurvey Week Logistics– Media/PR– Data

I l t ti T (60)• Implementation Team (60)• Volunteers (163)

Commitment of ExistingCommitment of Existing Resources

• Housing– Temporary housing optionsp y g p– PHAs for HCVs – set asides & preference points– Project Based Section 8j– SHP grantees– VA HUD VASHU S

• Support services– SAMSHA grantee– SAMSHA grantee– PATH grantee

DES outreach funds– DES outreach funds

Monday, April 19thMonday, April 19th

Interview MethodologyInterview Methodology

• 36 Teams – 2 experts and 2-3 volunteers

• Canvas same geographic area for 3 consecutive days

• Asked each person encountered on the t t t ti i t B i t t!streets to participate. Be persistent!

S i h f $5 M D ld ift• Survey in exchange for $5 McDonalds gift certificates

Tuesday - Thursday

Jose

Clyde

405 Facebook Fans!

Friday, April 23rd

Interview Results

• 262 chronically homeless adults identified & surveyedsurveyed

• 106 (40%) with high mortality risk (vulnerable)• 106 (40%) with high mortality risk (vulnerable)

208 (79%) pict es allo ed• 208 (79%) pictures allowed

“V l bl ” l h h t l t 1• “Vulnerable” are people who have at least 1 mortality risk factor, rank ordered by length of homelessnesshomelessness

Downtown PhoenixDowntown Phoenix

Prevalence of Risk Indicators

Risk indicator Average From All Sites Phoenixg

Sample Size 4362 262

Tri-morbid 30% 24%

3x hospital last year 12% 11%

3x ER last 3 months 10% 5%

> 60 years old 10% 8%

HIV+/AIDS 3% .3%

Liver Disease 10% 8%Liver Disease 10% 8%

Kidney Disease 5% 3%

Cold/Wet Weather Injury 10% 7%Cold/Wet Weather Injury 10% 7%

% vulnerable 42% 40%

106 (40%) of those surveyed met at least one High-Risk Criteria

Age/Seniors

• 24 (9%) people are over 60 years oldy

• Oldest respondent was 77 years oldyears old

• 10 of them report being homeless for over 10 yearshomeless for over 10 years.

• The longest has been homeless for 30 yearshomeless for 30 years.

Length of Homelessness

7.88.0

9.0

5 26.0

7.0

5.2

4.0

5.0 Non-vulnerableVulnerable

2.0

3.0

0.0

1.0

Length of Homelessness

Mental Health & Substance Abuse

113

150

113102

100

50

All

17

50

0Mental Illness Substance Abuse Dual-Diagnosis

89% of respondents report at least one behavioral health issue

Veterans

55

50

60

40

2120

30AllVulnerable

10

20

0

21% of respondents are veterans

Youth & Foster CareYouth & Foster Care

• 11% of respondents reported having been in• 11% of respondents reported having been in foster care 8 d t d 25 ld• 8 respondents were under 25 years old

• 2 respondents under 25 have mortality risk specific to that age group

• 2 respondents under 25 have mortality risk for p yadults

• Youngest respondent was 19 years oldYoungest respondent was 19 years old

Ethnicity/Race of the 106Ethnicity/Race of the 106

• 58% Caucasian• 58% Caucasian• 13% Latino13% Latino• 12% African American% ca e ca• 11% Native Americans

Gender of the 106Gender of the 106

• 81% male• 81% male• 19% female19% female• 1% transsexual% t a sse ua

ER & Inpatient Hospitalizationsp p

168180 168

129120140160180

6080

100120

0204060

• Annual estimated cost of ER = $632k

0Emergency Room Trips 3 Months Inpatient Episodes Last Year

Annual estimated cost of ER $632k• Annual estimated cost of inpatient hospitalizations =

$382k$• More than $1 M spent on health care for 262 people

Health System Impactsy p

31 3030

35

26

20

25

17

20%

15

20All

20%

5

10

0BannerDesert

CarlHayden

MaricopaCounty

Banner GS St. Joseph

24% report having no insurance

Income SourcesIncome Sources

79 8180

90

6160

70

3520%

40

50All

2020

30

0

10

Social Public Work On Off Books Panhandling RecyclingSecurity Assistance Books

Victims of Violent Crime & Brain Injuryj y

• 95 (36%) report being a victim of a violent attack since becoming homelessviolent attack since becoming homeless

• 64 (24%) report suffering from a brain injuryinjury

Thank you to our sponsors!

And then, we began HOUSING…

(based on medical vulnerability(based on medical vulnerability, not entitlement)

H3 Score Card

E d th• Engaged on the streets = 2

• In temporary h i 3housing = 3

• In permanent housing = 5

Troy

Jesse

Next…

• “Wild Bill”d• Donna• John

What’s next for us?

• Continue to house the first 50• Continue to house the first 50.

B i th d l h t li• Bring the procedural changes to a policy level. Solidify the systems changes.

• Broaden use of the Vulnerability Index.y

• Potential evaluation/publication with ASU• Potential evaluation/publication with ASU.

• Replicate in other communities…Tucson!