Republished by permission of author Gerry La Londe-Berg* from his website Who Cares and So What.
I received this question about ACCESS Sonoma in the context of the buying of local hotels for the most frail individuals who are homeless (see below). The article says that the Azura homeless residents will have access to something called “ACCESS”. This post explains the terms and programs.
Before I go into that I want to point out that this proposal allows Sonoma County to have housing units at just 36% of the cost of what “regular” Affordable Housing costs us now.
From the news article from NBC Bay Area, dated November 11, 2020, “The $8 million acquisition of the 44-room Hotel Azura was made through the State of California’s Project Homekey program, established in June in response to the COVID-19 health emergency. Officials said the hotel on Healdsburg Avenue would be converted into interim housing for up to 66 individuals when escrow is closed, possibly by next week.”
$8,000,000.00 for 44 units is $181,818.18 per unit. Affordable Housing developers like EAH, Burbank, etc. are building full size apartments for approximately $500,000.00 per unit. So, although less in size, the cost comes in at just 36.36% of more expensive affordable housing.
Here’s some information to help you understand the “Access” programs.
Sonoma County has three (3) distinct activities which are referred to as “Access”.
There is the high level management group which tries to integrate County Safety Net programs at the County Administrator’s Office (CAO office).
There is the Behavioral Health Access Team which is the more historic and traditional “Access Team” (Health Services Behavioral Health division).
There is a transit related Access project for seniors and folks with disabilities. (Area Agency on Aging) Sonoma Access (senior transit) https://www.sonomasenioraccess.org/
I am going to talk here about ACCESS as it relates to the Behavioral Health Access Team but you can read about Management Leadership here.
The Behavioral Health Access team – 565-6900 or 800-870-8786 is the screening process then service delivery for people with behavioral health challenges.
Our multidisciplinary teams provide these services:
- Integrated Health Team – integrated primary care and specialty mental health services
- Older Adult Team – for adults ages 60 and older
- Community Mental Health Centers – regionally-based outpatient specialty mental health services”
The Behavioral Health Department is also the umbrella for an effort of departmental collaboration called the IMDT:
The Interdepartmental Multi-Disciplinary Team (IMDT) model overcomes the issues of program silos by allowing County Departments, Agencies and Community Service Providers to share information about shared clients. The IMDT consists of frontline staff: clinicians, social workers, Adult Protective Service workers, probation officers, housing specialist, and eligibility workers who work to collaboratively coordinate care and goals to address the holistic needs of the vulnerable residents they serve.
The difference between the Behavioral Health Access Team and the IMDT is related to where in the process the person being served is. The Access team as described above works with people with chronic and persistent behavioral health issues that need to be served over the long term. The IMDT team as described is related to screening and introducing individuals to the right level of service. The web site explains each “cohort.”
IMDT has six cohorts, teams that work with specific groups of people. They are Emergency Rapid Response, High Needs Homeless, Emergency Department High Utilizers, Mental Health Diversion, Homeless Encampment Access & Resource Team (HEART), and COVID-19-Vulnerable.
In gradients of increasing support and services: The HEART team (Homeless Encampment Access & Resource Team) works with people who have no home or residence. They work closely with community nonprofits as well as the HOST team (HOST is Homeless Outreach Services Team, which is most closely associated with the City of Santa Rosa and Catholic Charities). HOST is sponsored by the City of Santa Rosa and the Water Agency as well as the Community Development Commission (CDC).
Another stage is what we used to call Whole Person Care (WPC) and which is now referred to as the High Needs Homeless (HNH) program. People in that genre have specific qualifications designated by the funding source. The Whole Person Care program is a state funded program in multiple counties throughout California. The criteria for that are: first of all, the person is on Medi-Cal, second they are homeless, and, third, they have a chronic and persistent behavioral health issues and meet one of several other criteria. These criteria include frequent use of health care resources, substance use disorders, or criminal justice involvement.
High Needs Homeless staff persons do outreach and engagement to qualify people and then passes people forward to Intensive Case Management (ICM). ICM lasts for a period of time until the issues are resolved – for example the person is set up with therapy or healthcare or housing or SSI. In many instances they are passed along to the regular Behavioral Health Access team for ongoing care and case management. Each of these programs has various arrangements with community providers.
A critical aspect of the whole person care project (now “High Needs Homeless”) was it developed the interdepartmental multidisciplinary team (IMDT) with a very specialized Release of Information (ROI).
I have been a social worker since 1983 and what has been done with the IMDT in Sonoma County (as well as in other communities) is truly an innovation and a resource which is very valuable to the individuals they serve.
Through the County’s IMDT team program, they are able to have cohorts of individuals that they are following and who can be discussed with the rest of the community providers on the Team. Notably, all participants are asked to sign the ROI mentioned because everyone must respect the person’s confidentiality.
The HEART group has a weekly meeting on Tuesday; and the HNH (High Needs Homeless) group has a weekly meeting every Wednesday in which people from multiple agencies can talk about specific individuals and plan for their care.
It’s hard to understand the inner workings of most social service agencies but I can best describe it by talking about some of what happens in the meetings. Usually there are staff people from the health care clinics (such as West County, Petaluma Valley, Santa Rosa Community Health). There are also people from the nonprofit organizations who are part of the Release of Information and there are people from the public defenders or the human services department or the probation department; all of whom are concerned with the same group of people. The discharge planners from the jail are also regular and very important participants.
In this way if someone has been in and out of jail multiple times and has not been connected with services all of these folks can talk about what to do next. Another practical thing that happens is that the healthcare providers are able to tell the other service providers when the individual has their next healthcare appointment and then the HNH or HEART staff or others who are working with that person can help them get to their healthcare appointments.
This is all within the confidentiality “bubble” and with great respect for the individual’s rights and expectations. If you have done any work in mental health or human services in California you know that confidentiality is by far one of the most important things we are concerned about. The only thing that’s more important is the well-being of the individual and their right to decide what they do.
The IMDT process as developed under Whole Person Care phase and the leadership of the County has developed a very practical way to serve the highest needs users. This is important because the highest needs users are also the most fragile people in the community and they are the most expensive users of multiple resources.
For our community, the value of group housing or intermediate housing as described in the hotels that are currently being bought serves individuals. Giving a person a pillow and door is a first step in actually helping them. For many years various advocates in the community have both accepted the Housing First concept that’s a national concept, and have complained about Housing First concept because of problems created by the lack of follow up services. What we have now in our homeless services system is the opportunity to fully realize one of the aspirations of Housing First. The promise of Housing First was that once you got people housed, then you could work with them closely to resolve multiple problems that might have brought them to become homeless.
The holistic Continuum of Care board (CoC) is charged with coordinating all of these activities in a community. The CoC is a federally required decision-making group because the federal Housing and Urban Development (HUD) Department is a primary funding source. It is in the interests of the people who have no homes and the people who serve them in the entire community to understand that we are at a very useful point.
There is an opportunity because of COVID-19 and the necessity to place people into special non-congregate shelters (NCS), as well as upgrade and modify of the congregate shelters such as Mary Isaac at COTS in Petaluma and Catholic Charities. We have a very clear sense of who the highest needs users are and most importantly what those particular individuals think they need. I hope we can build on this opportunity.
Some important follow up questions:
- Do community providers believe that their clients are being served by all this focus?
- Do the clients believe they are being helped by all this focus?
- Can the County incorporate some numbers about the number of people who’ve experienced life changes due to the efforts to these teams?
- And can we verify the answers to these questions?
Good questions, but we should start by giving credit where it is due… and learn from this new access we have.
* Gerry La Londe-Berg has been a social worker for 37 years. He was a founding member of Homeless Action! and also SHARE Sonoma County. He has worked for Human Services Departments in Sonoma, Riverside and San Bernardino counties. Prior to his public sector work, Gerry worked for eight (8) years with Catholic Charities in Santa Rosa and Eureka. Gerry began his career working with people who had developmental disabilities. Gerry grew up in Southern California and now lives in beautiful Sonoma County.