VNA Foundation :: Model Proposals

Model Proposals - Housing Opportunities for Women, Inc.

One of VNA's grantmaking priorities is to fund programs which can demonstrate objective measures of their impact on a population or problem. The following proposal, submitted by Housing Opportunities for Women, Inc., not only proposed well-defined and measurable objectives in its grant narrative to VNA, but also clearly explained how its request to fund a Patient Navigator would positively impact the specific healthcare needs of its clientele.

The proposal was approved in full by the VNA Foundation Board at its February 2, 2006 board meeting. We are pleased to offer it as a model proposal to grantseekers, and as another agency that evaluates well the services it provides to people who are homeless.

PROPOSAL NARRATIVE

Our Request

Housing Opportunities for Women, Inc. (HOW) requests a grant of $15,000 from the VNA Foundation to support the funding of a Patient Navigator position to provide advocacy, referral services and improve access to prevention screening for the homeless women and children in HOW's Permanent Supportive Housing Program.

Established in 1983, HOW's mission is to provide permanent solutions to the problems of homelessness and poverty for women and children in Chicago - and to advance the goal of ending homelessness nationwide. To meet this mission, HOW has come to recognize the absolute necessity of expanding, and more effectively coordinating, client health services provided to HOW participants.

HOW is seeking funding to support the recent hire of a Patient Navigator who conducts outreach, builds relationships, and educates clients, while ensuring that prevention screening and follow-up treatments are readily available. This individual is positioned to help clients make their way through today's complicated health care system - whether it is translating technical medical terminology, explaining insurance benefits and limitations, making appointments for referral screenings, following-up to ensure appointments are met, or accompanying participants to referral services when necessary. The Patient Navigator is helping families to develop skills to traverse community health services as one of their long-term success factors for economic and housing stability . And most importantly, this individual is establishing and cultivating trusting relationships with HOW's clients.

Healing the Trauma of Homelessness

People who are homeless are twice as likely as the general population to have chronic health problems but less likely to have access to adequate health care or insurance. The majority of p articipants in HOW's Permanent Supportive Housing Program have mental and/or physical health issues that include depression, bipolar disorder, obesity, developmental disability, diabetes, asthma, cancer and HIV/AIDS - and many struggle with histories of substance abuse, the legacy of physical and sexual abuse and domestic violence. Many have never been educated about self-care or the importance of health maintenance, nor have they had access to consistent health services.

To address the varied and complex health challenges of homeless families, HOW seeks to offer a variety of community-based prevention efforts, early intervention strategies and connections to comprehensive treatment programs - providing clients with a road map to get through the complex health care system. The position was recently created in response to the increasing demand for thorough health services as HOW's client population continues to grow. This individual is providing health services specifically tailored for HOW's client population.

In hiring a Patient Navigator specifically for HOW's clients, we have created a safe, trusting environment for women to discuss sensitive health matters - concerning both themselves and their children. This continuity of services will also aid HOW case managers interdepartmentally by creating a steady flow of client information. With employment, recovery and housing specialists already in place, the Patient Navigator is furthering HOW's comprehensive, collaborative approach in aiding women toward economic independence. The goal of this program expansion is to empower HOW families as they obtain the resources needed to improve and maintain their physical, emotional and spiritual health - a necessary prerequisite for maintaining their long term housing stability.

Transforming the Response to Homelessness

HOW is at the forefront of a growing national movement to end homelessness-in Chicago and increasingly across the nation. HOW holds firmly to the belief that when homeless individuals with chronic medical conditions are able to focus their energies on healing and maintaining health, rather than straining to find a place to sleep each night, their health outcomes will improve, thereby greatly increasing their chances of becoming economically independent.

The U.S. Interagency Council on Homelessness, created to coordinate the work of federal agencies around this issue, has been encouraging cities and states to create ten-year plans to end homelessness. Chicago was among the first major cities to respond to the call. Chicago 's ten-year plan - based on an unprecedented public/private strategic planning process in which HOW provided leadership - stands as one of the most ambitious nationwide. It seeks to end homelessness in Chicago by transforming the city's shelter-based system into a "Housing First" approach - placing homeless people in permanent housing as quickly as possible, then providing case management and linkages to community-based services - coupled with prevention. Research has shown that providing services in a permanent housing setting, not only leads to better outcomes, but is less expensive than the cost of habitual shelter stays and the emergency medical services often required by the chronically ill homeless.

HOW was among the first nationwide to implement the Housing First approach. HOW recognized that the emergency system established to respond to homelessness often worsened instability, as women and children moved from shelter to shelter. Since HOW's inception , 90% of the women, in HOW's entering Permanent Supportive Housing Program have retained their apartments, and 100% of those who graduated from the program have obtained and retained housing on their own. More than 40% of the participants have reunified with their families, with 80% of the reunifications successful. While 90% of those in substance recovery have maintained sobriety, many clients have a long road ahead of them as they work toward healing the physical and mental scars of addiction.

Housing First / Permanent Supportive Housing

HOW provides permanent supportive housing through a combination of apartments in buildings it has acquired, rehabbed, and now manages, together with apartments that it rents from landlords on participants' behalf in Rogers Park, West Rogers Park, Edgewater or Uptown. This approach helps overcome barriers such as lack of good credit and ex-offender status. Participants work toward the goal of assuming personal responsibility for their lease and transitioning out of the program. Our specifically tailored programs include:

Singles Two, Family Two: Time-limited to two years, these programs provide appropriately sized apartments for families and unaccompanied women. The focus is on helping women become financially independent through increased skills, income, and job retention. Once they are financially independent, women assume responsibility for their leases, allowing them to remain in their home while transitioning out of the program.
Housing for Women with Disabilities: More than half of HOW's subsidized housing units are designated for women with disabilities, both with and without families. There is no time limit on participation in this program, and all participating women have a disability that prevents them from obtaining independent permanent housing-such as history of mental illness, dual diagnosis, a developmental disability or chronic substance abuse. Support services focus on helping women access needed services, integrate into the community, and achieve maximum self-sufficiency.
Chicago Housing for Health Partnership (CHHP): HOW has partnered with health care, respite care, and housing providers to develop and implement a Housing First strategy to increase housing stability and health outcomes for people who are chronically medically ill. Women enter the CHHP program with an array of medical issues, including asthma, cancer, diabetes, and HIV/AIDS, and receive specific support services to address their medical and financial needs.
HomeFirst: This program targets a population that is ineligible for traditional housing subsidies: working women with incomes of $10,000 to $30,000 who simply do not earn enough to afford independent housing. Funded from the private sector as a three-year pilot project, HomeFirst gives employed women a stable living situation as they work to improve their education and job skills and become economically independent.
Emergency Assistance: HOW provides immediate intervention for households that are at critical risk of becoming homeless, such as through eviction. HOW responds to each woman's and family's needs, linking them with services and providing one-time cash grants for rent or utilities.

HOW'S Population Served

During FY 2005, HOW served 139 households comprising 73 families with 153 children and 66 unaccompanied women-23% more families and 27% more children the previous year. More than 90% of HOW's participants are African American, with the remainder of women and children being Asian, Native American and Caucasian. Their ages range from 23 to 61 - with the average age being 41.

For the 73 families served in FY2005, a significant majority are seriously compromised, having witnessed and/or experienced violence in their lives, and dealing with numerous physical and psychological issues. Forty-four percent of HOW's clients suffered with chronic health problems including asthma, diabetes, HIV, obesity and other chronic health conditions that need to be managed with proper intervention and ongoing medical care. Eighty percent struggled with mental illnesses and/or chemical addictions.

These chronic health conditions experienced by HOW's clients require regular uninterrupted treatment and are extremely difficult to treat or control without adequate housing and consistent medical attention. With fractured or inadequate care, clients with chronic illnesses will be less likely to maintain employment, obtain their educational goals and graduate from HOW's programming within the prescribed time limits. When clients' health status remains compromised, success rates within the program dwindle.

Over a third of the women did not complete high school. Over 50% of participants have experienced physical, sexual, emotional abuse and/or domestic violence.. Currently more than a third of the participants have some criminal history, which negatively impacts employability and limits career choices.

Comprehensive Support Services

Once safely housed, preventing displacement becomes the focus of ensuring women's and children's well-being. Support Services are an integral component of HOW's Permanent Supportive Housing Program - and all HOW participants receive support services that are tailored to their needs and the needs of their children. With case managers presently carrying high caseloads, while endeavoring to create individualized plans for each client, the addition of a Patient Navigator is crucial. Here, the impact of Support Services will be significantly expanded, offering a more effective environment for the healing and enrichment of HOW's women and children. Part case manager and part patient advocate, the Patient Navigator will work closely with Support Services.

Comprehensive Case Management is the linchpin of HOW's Support Services for both individuals and families. Case managers work with each woman to develop Career Plans and a Transition Plan with short- and long-term goals, and then provide the support and assistance each needs to accomplish her goals. This consistent, on-site service delivery is imperative. With the addition of a Patient Navigator, crucial services and focus will now be more accessible as the navigator helps clients overcome obstacles through encouragement, advocacy, and care coordination.

Because HOW's clients suffer from chronic health conditions that often impede their ability to retain and obtain employment - such as missing work to spend a day in the emergency room or experiencing discrimination due to obesity or histories of substance abuse - success within the housing program will increase as treatment plans and other services are more readily available. Poor health also affects clients' social stability and access to social support systems. Many clients have experienced delayed graduation rates in time-limited programs due to chronic mental and or physical disabilities. The presence of a Patient Navigator is helping clients get on their feet, expedite their completion of HOW programming, and obtain the ultimate goal of economic independence.

Caring for the Children

Children who have experienced homelessness are in fair or poor health twice as often as other children, and have higher rates of asthma, ear infections, stomach problems, and speech problems (Better Homes Fund, 1999). Vital services for this population involve identifying when children are at-risk - socially, emotionally, and physically. HOW needs to increase focus on this population who also experience more mental health problems than their traditionally housed counterparts, and ensure that each child receives the adequate vaccinations required for school attendance.

Presently, HOW's case managers work to ensure that each child receives the wellness care they need to aid in their recovery and the educational aid necessary to help level the academic playing field. With the addition of a Patient Navigator, children have greater access to the healthcare they need and deserve with thorough prompt diagnosis and treatment. This individual will also contribute to much-needed educational endeavors by providing resources for children on health and wellness and conducting youth-focused seminars.

Health Care Needs of Homeless Women and Children

People who are homeless are twice as likely as the general population to have chronic health problems, but less likely to have adequate health care or insurance. And the health issues of homeless women, in particular, are varied and complex. Many of HOW's clients have lived without health insurance for years, or the majority of their lives, and have little knowledge of navigating the current healthcare system. Many have come up against a variety of cultural, economic, and social barriers - involving difficulties in understanding complex medical terminology or accessing patient information, for example.

Seeking attention for health care becomes a low priority for women who do not know where they or their children will sleep each night, or where they will find their next meal. Many of HOW's clients have a history of ignoring health issues until they can no longer go untreated, at which point emergency rooms are utilized as a last resort.

Patient Navigators can help everyone, but are particularly important for the poor and disadvantaged. Research repeatedly shows how easily the obstacles to healthcare and better health can defeat all patients, especially those with fewer resources. The addition of a Patient Navigator is helping HOW's underserved participants overcome these obstacles through encouragement, advocacy, education and care coordination. With the availability of these services, clients can begin to build a foundation of health and wellness in their lives.

Homeless Women and Physical Health

At HOW, participants suffer from chronic pain, heart disease, diabetes, respiratory ailments, obesity, HIV and substance abuse. They also experience chronic stress associated with domestic violence, sexual assault and other issues connected to homelessness that have an adverse affect on their physical health. Obesity is a particularly severe issue for clients at HOW, with more than half clinically overweight.

With the addition of a Patient Navigator, clients' health will be increasingly monitored, and referrals, follow-up and advocacy will be more consistent. Efforts to ensure preventative care, such as receiving mammograms and yearly well-woman exams, will become a part of HOW's regular programming. Periodic health education workshops and seminars - focusing on lifestyle choices and risk reduction - are also being facilitated by the Patient Navigator.

Homeless Women and Mental Health

People with serious mental illnesses are over-represented among the homeless population. While only 4% of the U.S. population has a serious mental illness, five to six times as many homeless people (around 30%) have serious mental illnesses. At HOW, 36% of clients are struggling with mental illness and more than 70% are struggling with a combination of mental illness and chemical addictions

According to a U.S. Census Bureau survey (2004), homeless service providers in Chicago reported that 40% of homeless individuals did not have their mental health needs met. According to the Regional Roundtable on Homelessness, a forum that works to improve strategies for understanding and addressing homelessness throughout northeastern Illinois, almost 47% of the homeless reported that being released from a hospital, mental health facility, prison or institution with no place to go contributed to their homelessness. The Regional Roundtable stated that those who have mental illness had a significantly greater and unmet need in nearly every category including getting medication, mental health care, substance abuse treatment, help finding a job, getting reconnected to family, obtaining medical care and case management.

To augment HOW's existing mental health services, the Patient Navigator is instrumental in ensuring clients receive comprehensive mental health screenings; referrals to clinicians and other mental health practitioners; assistance in obtaining medications; and receive monitoring to the adherence of medication regimens.

Homeless Women and Substance Abuse

Homeless women in the U.S. comprise a sub-population at high risk for substance abuse, with rates of substance use disorder ranging from 16% to 67%. At HOW, nearly than 70% of participants have a substance abuse history.

According to recent reports from The Regional Roundtable on Homelessness, substance abuse was cited as the most common health issue among the homeless, followed by physical and mental health problems. The Patient Navigator will work closely with HOW's on-site Recovery Specialists who assess participants' substance use histories and develop individualized "Contracts for Sobriety" to support each woman's continued recovery. The navigator will ensure that appropriate referrals are made to specialists for health issues resulting from prior use. Additionally, the Patient Navigator will oversee all aspects of drug testing clients, along with providing educational support on issues related to substance abuse.

In addition to serving in a leadership role, HOW's outcomes and achievements demonstrate successful programs and expansion to address unmet needs:

More than 90% of the women and families in HOW's permanent supportive housing have retained that housing since the program's inception.
More than a third of HOW participants have reunified their families; 90% of the family reunifications have been successful.
In FY05, 85% of those who exited the permanent housing programs obtained and retained independent permanent housing; 85% of those in recovery remained substance-free; 65% of those who were employed retained their employment; and 27 households avoided becoming homeless thanks to HOW's rental and/or utility assistance.
HOW completed the first of two building renovations for new permanent supportive housing in FY03, with the second completed in October 2004 .
HOW successfully converted two transitional housing programs into permanent supportive housing.
The number of HOW's permanent supportive housing units grew from 10 in February of 2000 to 123 units at the close of FY05.
HOW was honored with the Community Partnership Award in 2005 by DevCorp North, a business, community and economic development corporation in Rogers Park, at their tenth annual awards benefit - the Rogers Park Renaissance.
HOW was one of eight agencies selected by the Chicago Foundation for Women for SHOW 21 (Sustainability of Healthy Organizations for Women into the 21 st Century), a two-year effort to create an organizational sustainability/asset mapping tool.
HOW recently presented its Housing First program models in workshops at the annual NAEH conference in Washington , D.C. , and at "Shifting Gears: Fast Track to Housing," a regional conference organized by the Charles and Helen Schwab Foundation in California .
HOW was one of 14 prominent Housing First programs nationwide featured in a new research study being conducted on behalf of NAEH.

Health Services Expansion Overview

At HOW, we believe we can begin to build equality and justice for homeless women and children by creating a support service model in which participants obtain quality medical care. Creating a solid outreach program that encourages clients to become aware of the need for prevention screening and helps them overcome barriers to healthcare services is crucial to their journey toward independence.

HOW is seeking much needed funds to further support its Health Services Program, including the Patient Navigatorwho manages clients' access to health services, makes referrals, ensures follow-up, helps families develop the skills needed to access community health services, and therefore values these skills as one of their long-term success factors for economic and housing stability. This new staff member has joined HOW's blended management team of case managers, recovery specialists, an employment specialist and housing department, who together provide support services to the women and children of HOW's Permanent Supportive Housing Program.

Health Services Coordinator Job Description

HOW's Health Services, coordinated by a Patient Navigator has initiated and will maintain valuable relationships with community health services providers. HOW currently has relationships with St. Francis, Mercy, Stroger, Rush, Weiss Memorial and University of Chicago hospitals, as well as Near North Health, C4, Devon Dental, Goldie's Place, Gallilee Medical, Chicago Board of Health, Touhy Health Center, Heartland Health Outreach, among others. With the addition of a Patient Navigator, HOW will not only cultivate these relationships, but can seek new partnerships throughout the area.

The Patient Navigator is establishing relationships with HOW's participants and becoming familiar with the unique medical, psychological, economic, cultural and social problems of HOW's clients; treating them with the same respect and empathy bestowed to patients in the mainstream; being predictable; helping to simplify medical regimens; scheduling frequent follow-up visits; networking with local substance programs and social service agencies; and enrolling patients in Medicaid.

In addition, the Patient Navigator is responsible for:

Providing thorough, written assessments and histories of participants' physical and psychological health;
Coordinating access to service providers for both mental and physical health services, including referrals;
Assisting patients in overcoming barriers within the healthcare system to ensure prompt diagnosis and treatment;
Linking clients to yearly well-woman and mammography exams;
Helping clients obtain and manage their medications;
Providing educational and outreach services, including fitness and nutrition support; and
Ensuring the provision of family planning services.

Measurable Objectives of HOW's Health Services

The overarching goal of Health Services and the addition of a Patient Navigator is to provide advocacy, referral services and improve access to prevention screening for the homeless women and children in HOW's Permanent Supportive Housing Program. The Patient Navigator is working toward ensuring the stabilization of clients' health, so that they achieve and maintain economic self sufficiency and independent housing. We believe this is best accomplished through the expansion and more effective coordination of case management support services through HOW's Patient Navigator and its Health Services Program. The specific outcomes and objectives this expansion of services is expected to achieve are:

Outcome Objectives

The Patient Navigator will ensure that clients' have a comprehensive knowledge and understanding of their current health status.

100% of HOW participants with identified health care needs will have well documented, written assessments of their current physical and psychological health.
100% of clients will be continually educated on their health status throughout their participation in HOW programming

Participants will have increased access to and understanding of treatment and community resources.

80% of HOW participants with existing medical and psychological conditions, who engage with HOW health services, will attend 80% of their medical/mental health appointments.
100% of those participating in HOW health services who need referrals will receive them.

Participants will enhance their well being through education and preventative measures, resulting in improved overall health.

50% of HOW participants will participate in fitness, nutritional and other "well woman" initiatives.
80% of those participating in HOW health services and educational programming will self-report an increased awareness of their own health, health risks and well behaviors.

Evaluation and Impact

HOW ensures that its programming is high-quality and responsive to the needs of its participants through an ongoing evaluation process that incorporates quantitative and qualitative methods. HOW's overarching goal is for homeless women to secure and retain permanent housing and achieve maximum self-sufficiency. HOW establishes short- and long-term outcomes and objectives for each individual and category of service, which are tracked and measured through case management and other program records.

Strategies used to gather input from HOW's high risk and underserved population include a thorough intake process performed by case mangers which includes administering the Psychosocial Assessment profile. Program staff also creates a thorough health history of clients as they enter the program, as case managers work to assess which HOW program is most appropriate for the client based on their individual mental and physical health care needs.

As HOW undertook the significant effort of transforming its programs into permanent supportive housing, it created a Quality Assurance Task Force to quickly identify and address issues. Quarterly reporting systems were implemented that encapsulate both aggregate services provided and individual clients' progress. Each month, staff members submit data regarding participant demographics, needs, and circumstances, as well as services and referrals provided, to the Director of Operations, who compiles and analyzes the data. HOW produces quarterly numeric reports and an annual narrative report comparing goals to actual achievements. HOW also solicits qualitative input from clients, using tools that include an annual client survey and suggestion boxes at all HOW buildings. Importantly, client reporting will be enhanced with expanded with health and wellness evaluations with the addition of a Patient Navigator.

Last year, the participant satisfaction survey revealed that a vast majority felt welcomed into the program and were satisfied with services received. Most felt they were moving toward economic stability and independence, and were satisfied with their housing. All respondents replied 'yes' to the question "If a friend were in need of similar help, would you recommend our program to her?"

Conclusion: Seeking Your Support

In its 22 year history, HOW has helped thousands of women and children break the cycle of poverty and homelessness by achieving long-term economic stability and permanent housing. HOW was among the first to successfully transition from the crisis-management approach of the shelter system, when homelessness first emerged as a visible problem in the 1980s, to the pro-active provision of permanent supportive housing-an approach critical to a family's well being and to children's educational future.

This strategic orientation has led to the rapid increase in HOW's program capacity. HOW was one of only two agencies in Chicago to receive money for new programming this year from The U.S. Department Housing and Urban Development (HUD) and we recently added 20 new scattered-site units to our program. In FY 2005, HOW served 139 households comprising 73 families with 153 children and 66 unaccompanied women -- 23% more families and 27% more children than the previous year. Having achieved a high ranking with the U.S. Department of Housing and Urban Development, is also seeking opportunities to develop additional building(s).

In FY06, HOW anticipates that approximately 64 percent of its funding will come from government sources. Approximately 75 percent of these government funds will be specifically designated as rent subsidies. HOW must raise the matching funds needed to provide the support services that ensure HOW's growing number of families receive the case management they need to develop the highest degree of self-sufficiency and, where possible, transition out of the program.

Achieving this degree of self-sufficiency is dependent upon a state of physical and mental well-being, taken for granted among the general population. Among homeless families however, both public health research and HOW's practical experience over 22 years tell us that consistent and quality education, prevention, clinical and follow-up services are required to achieve these goals.

HOW is actively reaching out to a broad array of foundations, corporations and other donors to ensure the longevity of these Health Services. HOW recently received funds from the Washington Square Health Foundation, and is also seeking grants from the Blowitz Ridgeway Foundation and the Foundation for Health Enhancement, among others. HOW's track record of success, and rich database of funders, further ensure the long-term viability of expanded Health Services.

The Washington Square Health Foundation has provided HOW with a grant of $15,000, with an additional $15,000 pending mid-cycle. A $15,000 grant from the VNA Foundation would be vital in helping HOW to create innovative, family-focused health services for homeless women and children. We would welcome the opportunity to describe our program in more detail.

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More than half of uninsured families earn an annual income of less than $35,000 for a family of four and private health insurance can exceed 10% of this income.
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