Using a Scattered Site Housing First Model to Combat the Opioid Epidemic

Written by guest blogger, Christine Simiriglia, President and CEO of Pathways to Housing PA.

People are dying at an alarming rate. Across the nation, the opioid crisis has communities working overtime in search of solutions.

Philadelphia is feeling the effects particularly hard. The city’s Kensington neighborhood remains “ground zero” for some of the purest, cheapest heroin in the country. Tragically, Philadelphia is on track to witness 1,200+ opioid-related deaths in 2017, a 33 percent increase over 2016. And individuals experiencing homelessness are at increased risk.

In late 2016, Pathways to Housing PA launched a pilot program designed to focus on chronically homeless individuals with long-term opioid addiction. Pathways combines a traditional Housing First model with new strategies in street outreach, including needle exchange, Narcan disbursement and training, and immediate access to Medication Assisted Treatment (MAT). These strategies are designed to meet the needs of chronically homeless individuals with opioid use disorders.

Pathways’ program is successful because it includes permanent housing as an integral part of the treatment plan.

In many instances, people who access treatment immediately use drugs again. Housing, combined with wraparound services, breaks that cycle and eliminates many of the barriers to Medication Assisted Treatment.

Pathways’ new program builds on years of experience with a chronically homeless population with serious mental illness and other disabilities. In fact, Pathways is one of the first service providers in the county using a scattered site Housing First model with this population.

Pathways created a specialized assertive community-based team of peer specialists, substance abuse counselors, doctors, nurses, and case-managers to assist with the permanent housing of individuals with long histories of addiction, trauma, and chronic homelessness. It targets high-risk, high-need individuals with a harm-reduction strategy—and enforces no preconditions for housing. Staff place clients in permanent housing (fully furnished units chosen by the participants) and then provides services such as home-based intensive case management and care coordination; psychiatry and mental health counseling; nursing; medical care; and additional supportive services such as MAT.

Though the size of the program seems small, the impact is tremendous, scalable, and replicable.

To date, the team has placed 75 chronically homeless opioid addicts in permanent scattered site housing with the following outcomes:

  • 100 percent of the participants retained housing throughout the first year.
  • 52 percent of the housed participants received MAT or were abstinent during November 2017.
  • 100 percent of participants received Narcan training, as well as individualized overdose prevention plans. When overdoses do occur, the support team works with participants to strengthen overdose prevention plans.

This initiative is funded by the U.S. Department of Housing and Urban Development, the Philadelphia Department of Behavioral Health, Community Behavioral Health, and the Office of Homeless Services. Pathways recently expanded their Integration Care capabilities thanks to grants from the Substance Abuse and Mental Health Services Administration and the Pennsylvania Center of Excellence for Opioid Use Disorders.

There are no easy solutions to the opioid crisis, especially for those at increased risk. But if we can show this kind of progress in one of the most burdened communities in the nation, we know that there is hope beyond Philadelphia.

Christine Simiriglia is President and CEO of Pathways to Housing PA. She has worked in, written about, and provided training on just about every position imaginable in the behavioral health and homeless services systems for over 30 years.

To learn more about how resources for opioid abuse can be leveraged for people experiencing homelessness, please register for the Alliance’s upcoming Webinar, “Making the Connection: Homelessness and the Opioid Crisis, Thursday, Jan 11, 2018 11:00 AM – 12:30 PM EST.