Learn how a GBHI-SSH grantee in Cincinnati generates positive outcomes for its clients by embracing collaboration and community building.
In September 2009, Greater Cincinnati Behavioral (GCB) Health Services became a SAMHSA grantee in support of the organization’s Paths to Recovery (P2R) program. Funding was provided under SAMHSA’s Grants for the Benefit of Homeless Individuals-Services in Supportive Housing (GBHI-SSH) program.
P2R serves clientele that are among the most difficult to serve. Admission criteria include factors such as multiple arrests, longest tenure on the streets, and previously failed treatment at other local homeless and treatment programs. In essence, P2R is “the safety net for the safety net” for people experiencing homelessness in their community.
P2R has a total of five staff members comprised of four males and one female, three of whom are African American. Furthermore, the concept of, and experience with, recovery for some of the P2R staff is not new—some have personal experience with substance use. Their office is located in the Jimmy Heath House, a project based on the Housing First philosophy that has been a model project for the city. Its goal is to provide permanent housing for clients with the most bed nights at the local shelters over the last ten years.
The P2R project’s target population is the chronically homeless individual with chronic alcohol use. Since March 2010, they have served 76 permanent housing participants. P2R adopted the Housing First Model for this group, in addition to utilizing two other evidence-based practices: strengths-based case management and motivational interviewing. Additionally, all of their staff have been trained extensively in integrated dual disordered treatment and trauma-informed care and have received training from each of their participating homeless, mental health, and substance use systems.
What makes P2R exceptional is the vast amount of collaboration in almost every aspect of its operation. The overall project is a collaborative effort among three agencies in Hamilton County, Ohio: GCB Health Services, Alcoholism Council (AC) of the Cincinnati Area, and Over-the-Rhine Community Housing (OTRCH).
GCB Health Services, established in 1971, has over 300 employees and serves over 4,500 participants annually who live with mental illness and other related barriers. The AC, established in 1949, is the central access point for information, referrals, and treatment for substance misuse in Cincinnati. The AC employs two of the five P2R staff and also provides weekly clinical supervision to the project. OTRCH is a property developer and manager dedicated to providing affordable housing. OTRCH owns and operates the Jimmy Heath House, a 25-unit permanent housing program staffed by all three agencies, and manages Shelter Plus Care Program housing certificates for scattered-site residents.
Other significant partners include the Cincinnati Health Network, which provides medical, dental, and mental health services through the McMicken Clinic and the mobile medical van. Substance Abuse Resources and Disability Issues at Wright State University provides evaluation services integral to gathering outcomes and organizing data for sustainability planning for the program.
The collaboration starts with P2R’s outreach process, which includes getting referrals from city homeless outreach workers who participate in weekly street outreach, and from a monthly selection committee comprised of agencies that work with people experiencing homelessness. The committee includes representatives from AC; the Drop Inn Center, a local 300-bed shelter; the Cincinnati police department; members of the local business district; and case management teams. It also includes representatives from the local Projects for Assistance in Transition from Homelessness (PATH) team.
Another distinction of the P2R program is the sense of community established among participants who have helped shape the design and operation of the program. Furthermore, the programming that P2R offers is welcoming and consistent, 100% voluntary, and is attended on a weekly basis by 30% of their participants. The program includes weekly meetings and provides an open forum for participants to provide input, discuss concerns, and voice ideas for improvement. A women’s group was started at the request of the female participants. Each grant year ends with a series of focus groups that generate ideas and offer insight on what members feel has worked, and what needs to be improved with their programming. This collaborative environment has resulted in low turnover: over three years, there have only been seven discharges from their 76 admissions. Five of those discharges were due to death stemming from the myriad complications that alcohol use and homelessness can present.
P2R shared the lessons they have learned over the years. First, people who are both chronically homeless and who abuse alcohol are a very socially connected group; they want to participate and they all seem to know each other. Second, the majority of participants have remained in housing, take pride in their homes and work hard to maintain them. Third, good communication with landlords who are tolerant and responsive is imperative—letting landlords know that P2R cannot guarantee the behavior of their members, but they can guarantee that when a landlord calls, they will promptly respond.
For P2R, this is what success looks like: housing retention rates are 90% for 6-, 12-, 18-, and 24-month periods. Arrest rates were reduced by 68% during the first year of housing. Reductions in drinking: from admission to 6 months, and from admission to 12 months, and a reduction in the number of days participants report drinking to intoxication. Finally, 93% of their clients choose to participate in the voluntary group programming that P2R provides.
SAMHSA supports a trauma-informed approach to care that is distinct from trauma-specific interventions or treatments that only address the consequences of trauma.
Learn more about Housing First at the National Alliance to End Homelessness. Find information on the Shelter Plus Care Program at HUD Exchange.
Access more behavioral health and homelessness resources.