Supportive Housing Program For HIV+ Homeless Persons At Central City Lutheran Mission
In 1998 Central City Lutheran Mission's Board of Directors became aware of an acute need in the EMA (Emergency Metropolitan Area as defined by the Centers for Disease Control) encompassing San Bernardino and Riverside Counties. There was an absence of housing for HIV+ homeless persons. Shelters will not take persons who identify themselves as HIV+. Hospices are for persons with AIDS and with severe health care issues. Housing for HIV+ homeless persons was simply not available.
In 1996 a major shift occurred in the paradigm of providing care for HIV+ persons: the introduction of new medications that has meant that people move more slowly from HIV to AIDS. People are living longer, but not necessarily better. The poor and economically disenfranchised in particular have not experienced the same rate of improvement in the quality of life as those in other economic classes. Inadequate health care because of their economic status throughout their lives has meant that the HIV and highly toxic medications have not improved the quality of their life, although it has extended the length of their life.
In this context, CCLM began St. Martin's House – a transitional living space for HIV+ homeless persons. The purpose of this house was to provide a shelter for HIV+ persons coming from the streets, from prisons, from drug rehabilitation centers or from “shooting galleries” who had no place to go. While living in this transitional living space, residents were provided support services that:
· assisted them in obtaining entitlements
· made the necessary referrals for medical treatment
· provided support to encourage medical adherence
· provided nutritional counseling
· provided secondary prevention education and resources
· provided weekly support groups
· made requested referrals for more formal substance use counseling
· provided a safe environment for stabilizing in a new life style moving from homelessness to being a resident in a therapeutic community
It was soon learned that merely providing entitlements was not sufficient for this population. In most cases residents were dual-diagnosed, with HIV being the most recent but perhaps most “serious” diagnosis in the sense that it served as a “wake-up” call for better health. All residents who came to St. Martin's House were living well below the poverty level for a number of years. Some came from prison. Some were bi-polar. Some were on psycho-tropic medications and were paranoid-schizophrenics. Others had complications related to years of substance use, including liver failure. Still others were diagnosed with both HIV and Hepatitis C. In some cases, residents were still using substances.
With the support of HUD's Supportive Housing Program, CCLM expanded its work in 2000 – with the clear support of the Community Services Program of the County of San Bernardino's Coalition for the Homeless. A grant enabled the acquisition and renovation of eight abandoned houses for the specific purpose of providing Supportive Housing for persons choosing to be part of this therapeutic community. The program was supported by the Economic Development Agency of the City of San Bernardino and numerous religious congregations in the area, who provided “sweat equity” to renovate the houses and furniture once they were ready for occupancy.
Supportive Housing was meant to provide a number of services for the residents of these eight houses. The houses were not meant to be residential treatment centers for substance use. They were not meant to be hospices for persons living with AIDS. They were not meant to be houses for persons with serious disabilities that would require home-care or home treatment.
As a part of HUD's Supportive Housing Program, the houses were designed to be key elements in organizing a therapeutic community enabling persons who were legally diagnosed with HIV – and in some cases other illnesses – to have affordable housing during a difficult transition period in their life. In some cases, this would be eight to twelve months. In the case of two individuals, this has been for two years given the chronic depression associated with their illness. In no cases would it mean residential care or treatment. When residents agree to participate in a therapeutic community they agree to begin to take steps to care for themselves given the illness(es) they have. By participating in CCLM's therapeutic community residents agree to:
· end a prolonged cycle of homelessness
· to actively pursue entitlements
· to obtain medical treatment
· to confront substance use issues
· to adhere to medical regimens
· to improve nutrition
· to change individual behaviors that put others at risk
· to improve socialization options as a necessary step for individual support
· to end cycles of violence, both self-destructive violence and violence as a way for solving problems
CCLM provides qualified staff to assist residents in this Supportive Housing Program to meet their goals. Weekly support groups for all residents are required. In-take forms are kept on all residents. All residents' progress is charted and maintained in an effort to monitor progress in this therapeutic community. In addition, assessment is provided to all residents in an effort to develop an individual treatment plan encouraging the best use of the resources of this Supportive Housing Program in an effort to guarantee improved health conditions and to break a cycle of homelessness.
This approach has been extremely successful. In 2001 the Robert Wood Johnson Foundation's Community Healthcare Leadership Program's Award was given to CCLM's Executive Director, The Rev. David J. Kalke. Part of the program reviewed in making this award was the HUD-funded and supported Supportive Housing Program for HIV+ Homeless Persons. A video made by Seraphim Communications in April of 2002 contains footage including interviews with HIV+ residents telling their stories and the support this program has meant for them.
This Supportive Housing Program has received much technical support from outside agencies as a number of services are offered for the participants in this therapeutic community. The AIDS Clinic of the Department of Health of the County of San Bernardino provides medical attention. A number of agencies are available for receiving residents who seek a short-term residential substance use treatment program, returning to the Supportive Housing Program upon completion of the program. California State University-San Bernardino's Masters in Social Work program places interns with the project to provide counseling options, supervised by California State University faculty and certified MSW's in the community. The Nursing Department of California State University-San Bernardino has provided nursing students to work with residents in the areas of nutrition, psychological assessments and clinical depression. Qualified faculty work with students to assure top quality services and care. Pacific Lutheran Theological Seminary (Berkeley, CA) and Luther Seminary (St. Paul, MN) have provided seminarians to work with residents in the area of spiritual development, an area often important for HIV+ homeless persons who are seeking to be centered in new ways for living that can prevent homelessness and improve health care.
In addition, CCLM has its own staff who work with the residents in the Supportive Housing Program. CCLM as a case manger, an MSW and a pastor with years of experience in working with HIV+ homeless persons both in New York City and the San Bernardino area on staff. These staff do in-take, provide assessments, provide counseling and support and make necessary referrals, if necessary. They assist residents in obtaining entitlements and provide encouragement to assure medical adherence, secondary prevention practices and behavior that can prevent homelessness.
CCLM staff also is the catalyst for encouraging the residents to create a therapeutic community. By leading weekly support groups, inviting residents to organize recreational activities and encouraging house by house organization through the election of “house managers” and “recreational directors” residents themselves are given leadership roles that teach them new skills, provides psycho-social support and in many cases give residents a new reason for living. Moms with HIV+ babies are visited daily and their health is monitored, with referrals being made when necessary. Families have been reunited as adults have obtained custody rights for lost children. In some cases, when physically and psychologically possible, residents have gone back into the labor force and have moved on to get their own apartments and continue a new way for living. CCLM staff continue to provide them with support and resources to assist them in meeting their goals and maintaining their new homes.
In 2001 CCLM applied for another HUD grant to expand the current Supportive Housing Program. The goal is to move from the City of San Bernardino into the County of San Bernardino through the acquisition of seven (7) new units, providing housing for 28 more HIV+ homeless persons. Ranked high by the San Bernardino County Coalition for the Homeless, this project was seen as an important component in the continuum of care for homeless persons in our area. The project works specifically with disabled persons and specifically works to provide long-term supportive housing, ending cycles of homelessness.
This program will expand the therapeutic community for HIV+ persons. Targeting the poor, most at risk and hard to reach, this project will involve more persons coming directly from prisons, women with children and people of color, who are underserved in this EMA's continuum of services for HIV+ persons. Consistent with the therapeutic community described above all residents will be assessed and monitored. All will be referred to the necessary services by qualified CCLM staff. All will be guaranteed appropriate nutrition and a living environment that promotes secondary prevention care. All will be active participants in beginning to care for their own health and the health of other members of the therapeutic community.
The Supportive Housing Program operated by CCLM is an independent living program for adults who are HIV+, not yet living with AIDS. As such, it does not provide residential treatment or care. Rather it is a therapeutic community surrounding residents with quality professionals who can assist residents in medical care, psychological adjustment to living with HIV, substance use counseling and spiritual guidance. Our experience demonstrates the effectiveness of this approach to working with an HIV+ population at risk and hard to reach.
We are pleased to have been supported by HUD, the Economic Development Agency of the City of San Bernardino, the Economic Development Agency of the County of San Bernardino, the Ryan White Care Act, local congregations and to have been nationally recognized by the Robert Wood Johnson Foundation for this initiative. We believe that the expansion of this therapeutic community into the County of San Bernardino – with the support of HUD and Economic Development Agency of the County of San Bernardino – can only improve the quality of care being offered to a greater number of HIV+ homeless persons as we seek to break the cycle of homelessness and provide quality health care.
