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Rural Health Information Hub

Feb 12, 2014

A Concerted Effort to Help the Homeless in Vermont

Kathleen Belanger, Challenges for Human Services columnistby Kathleen Belanger

I just attended a piano concert with a breathtaking Chopin Sonata for the finale. I couldn't help thinking about all the elements integrated into this sublime experience:  the expertise of the composer who wrote the piece almost 200 years ago; the concert hall designed for superior acoustics; the funding that enabled the performance; the network of publicity that brought it to my attention; the volunteers taking tickets and staff working on all the other details; and, of course, the pianist, whose skill and artistry brought the piece to my own ears.

Rural human services is much like a concert.  In past issues I've discussed the importance of evidence-based services being tested, modified as necessary and provided in rural areas (Summer 2012 – no longer available online)—which is akin to the composer who writes the music for others to play. I've discussed philanthropy (Spring 2012 – no longer available online), important for delivering rural help, much like the funding that brings rural people classical music and the arts.  I've also mentioned the importance of local collaborations and, possibly the most important of all, local contact with local people (Fall 2012 – no longer available online).  Like a concert event, the collaborations enable the outcome, and like a performer, the local contact brings it to the audience/user and makes it live in the present.

Pathways Vermont appears to be one such concerted effort to achieve the health and well-being of those who were previously chronically homeless.  The program utilizes the evidence-based Housing First model, with the philosophy that all people deserve the right to housing, and that housing must be provided before anything else can be done.  It's very hard to help people learn skills and get jobs, tackle substance or alcohol addictions and/or learn to cope with past abuse while they are experiencing continuing trauma and simply struggling to survive on the streets.  Housing First utilizes a team approach with multidisciplinary staff, shared caseloads, and 1:10 staff/consumer ratios.  However, because Vermont is rural, with limited public transportation and housing, job challenges, and fewer health and mental health specialists that are often located miles from the clients, Pathways Vermont's rural adaption utilizes local service coordinators who establish and maintain relationships, and visit at least weekly in person to help clients access a range of services, tackle housing issues, etc.  The local coordinators have 1:20 staff/consumer ratios, supplemented by regional specialists who provide health care, mental health treatment, employment services, and a range of tutoring and educational skills, and by a regional housing coordinator who finds housing and works directly with landlords.  Finally, all clients are offered donated refurbished computers, and receive Internet access and in-person training in computer literacy.  They learn to manage Google calendars, meet with staff in Google “hang outs,” and have not only online appointments for services, but access to employment applications, education and peer support.

The urban model is transformed for rural communities through the local relationships. According to Laura Nicole-Sisson, Administrative Coordinator for Pathways Vermont, “In our rural areas, relationships are everything. In small towns, everyone knows you, and it takes a community effort to help integrate someone back into the community.”   Describing her organization's approach, Sisson continued, “We provide peer support. We don't tell our clients what their outcomes need to be.  Instead we listen to what they want and work with them to get it. We walk with them each step, and if they slip, we are there with them to find the way again.  It brings back hope and possibility, not just for them, but for all of us.”  And indeed, the project's hopes are well founded.  Compared to being previously chronically homeless, 85 percent of the 200 clients are in a stable housing situation on a given night.  And while the program costs approximately $40/night per client, other “housing” that clients previously received ranged from $62/night in state-paid motels to roughly $2,000/night in state hospitals.  The program has significantly reduced time in jail,  the number of visits to emergency rooms and hospital stays—all very expensive methods of treatment—and at the same time has increased the number of positive outcomes, including engagement in productive activity like schooling and employment.

Pathways Vermont is funded through a grant from SAMHSA (Substance Abuse and Mental Health Administration), the Vermont Department of Mental Health and the Vermont Department of Corrections.  Two key elements for the sustainability of rural evidence-based programs are funding for research, and funding for program continuance.  SAMHSA funded the evaluation study that demonstrated the positive outcomes and financial savings; continued evaluations will be necessary.  Because of “siloed” federal and state funding streams, investments in mental health and housing, like Pathways Vermont, often accrue savings to corrections, health and residential mental health care.  In this case, Vermont Corrections does participate in funding.  It will be important to note how Vermont will continue funding, and whether health dollars will be contributed and tracked.   If the funding streams are further integrated, or at least tracked, and if the program continues to be evaluated, it could be a model for other rural communities and states.

This is one evidence-based model, adapted for rural implementation, with sufficient funding support, locally formed relationships, and primary staffing supplemented by regional specialists and smart technology, all working together to change lives.  That's definitely music to my ears.

Kathleen Belanger, Ph.D., is Associate Professor of Social Work at Stephen F. Austin State University in Nacogdoches, Texas, and is a member of the RUPRI Human Services Panel, co-chair of Child Welfare League of America (CWLA) National Advisory Committee on Rural Social Services, and recipient of CWLA's Champion for Children award in 2005 for her work in rural child welfare. Belanger has published and presented on human services issues in a variety of publications and forums. In addition, she has worked for more than 20 years with rural communities, where she has helped found several non-profit organizations and advocated for rural resources.

Opinions expressed in this column are those of the author and do not necessarily reflect the views of the Rural Health Information Hub.

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