Old Pueblo Community Services with the Pima County Housing First Program
Pima County, Arizona
Added March 2023
NOTABLE FEATURES
- Pima County Justice Services in Pima County, Arizona received a SCA Pay for Success grant in Fiscal Year 2021.
- Jurisdiction geography: Urban; 1,052,000 residents
- Size of correctional facilities and populations incarcerated: 1,500 men and women at Pima County Jail
PROGRAM DESCRIPTION
Pima County officials launched Pima County Housing First (PCHF), a permanent supportive housing program, in 2019 to serve people experiencing unsheltered homelessness who have co-occurring mental health and substance use disorders and who are either returning from the county jail or at risk of entering the criminal justice system. Old Pueblo Community Services (OPCS), a local homelessness service provider, functions as the lead case planner for PCHF and partners with elected and senior government officials from Pima County and the City of Tucson, the Pima County Adult Detention Complex, and Adult Probation in Pima County to quickly connect participants to housing with low or little barriers of entry and intensive wraparound services.
As the lead case planner, OPCS case managers assess participants for eligibility, enroll them in the program, and begin Intensive Case Management services—an evidence-based permanent supportive housing service model—to reduce jail contact and increase housing stability. Program participants also receive trauma-informed services including motivational interviewing, harm reduction, and client-centered case management service planning, as well as rental assistance. During the rental assistance application process, case managers assist participants in obtaining necessary documentation (e.g., IDs, birth certificates, etc.); once they obtain a housing unit, case managers also employ housing navigation and retention services to help participants maintain their housing stability. If a person does not immediately receive housing and does not have a safe place to stay, OPCS also provides short-term bridge housing.
To support these efforts and expand PCHF’s ability to increase housing stability for individuals, Pima County officials received funding through the U.S. Department of Justice’s Office of Justice Programs’ Bureau of Justice Assistance Second Chance Act Pay for Success initiative in FY2021. This funding helps move PCHF from a pilot to an ongoing program to testing the expansion of the program with an outcomes-based contract. The outcomes-based contract incentivizes both jail avoidance as well as quickly moving people into permanent housing through the Housing First approach.
Lead Case Planners and their partners were asked to provide information about how their programs implement some of the Collaborative Comprehensive Case Plan priorities. See below for more information about Old Pueblo Community Services’ efforts.
Interagency Collaboration and Information Sharing
Thanks to an existing relationship with OPCS, Pima County officials entrusted OPCS with the role of the lead case planner and homelessness service provider for PCHF. They also understood that OPCS’ strengths as a lead case planner included an established referral pathway throughout the Pima County justice system, their role as a coordinated entry point for homelessness services, and their use of an evidence-based permanent supportive housing model. Their case planning and referral partners included the Jail Population Review Committee, Adult Probation in Pima County, Pima County Justice Courts, the Pima County Sheriff’s Department, the Tucson Police Department, Pre-Trial Services in Pima County, the U.S. District Court for the District of Arizona, and Pima County Public Defense Services. Now, as the lead case planner, OPCS case managers keep these partners informed about the housing and services progress of people referred into the program through regular case planning updates. This continued communication and OPCS’ responsiveness to new referral partners helps to maintain a trusting relationship, which, in turn, incentivizes partners to continue referring participants to PCHF for housing assistance.
Success for PCHF also comes from the local commitment and buy-in of both Pima County and Tucson leadership. Pima County continues to advocate for PCHF and shows a steadfast commitment to the program’s success and belief in the Housing First approach. Critical to the launch of PCHF, the city of Tucson has continued showing its commitment to shared success by setting aside housing vouchers for PCHF participants.
Staff Training
OPCS ensures that its staff receive comprehensive internal trainings as well as supplemental trainings from external organizations in trauma-informed care, motivational interviewing (both internally and through Arizona State University), the Housing First approach, harm reduction models, strength-based approaches to build on a person’s internal strengths and facilitate their choices in services, nondiscrimination, inclusion, and diversity. Staff are also required to stay up to date on fair housing practices and the Arizona landlord tenant laws.
OPCS partners with many outside organizations to broaden available trainings to staff. Partnering organizations include Arizona State University, the Arizona Trauma Institute, Sonora Prevention Works, and the Southwest Fair Housing Council—which provides annual fair housing training. Many of the trainings that OPCS staff receive are competency-based requiring staff to pass tests for certification, with third parties providing coaching and scoring to ensure competency targets are met.
Screening and Assessment
The screening and assessment process for PCHF begins when OPCS receives a referral from one of its justice system partners. Justice system partners begin the process by assessing the housing needs of the people they work with to see if they are eligible to participate in PCHF. Once deemed eligible, the person’s referral is sent to OPCS, where staff conduct an internal verification of eligibility to ensure that the person meets the criteria to participate in PCHF. Once the person is deemed eligible, they are added to the program waitlist and receive an acceptance letter to the program. A behavioral health assessment is then scheduled once they complete intake into the program to help determine the person’s clinical service needs. Following this assessment, OPCS staff also screen participants to determine their need for bridge housing. At the same time, staff also work with each person to create a service plan, which helps identify their priority housing needs.
OPCS also deploys an outreach team to reach eligible people in the community to help enroll them in PCHF, including individuals who believe they are eligible to participate in PCHF but do not have a referral from an approved partner. In these cases, staff work with individuals to reach out to a referring agency they are already working with to obtain referral to participate in PCHF.
OPCS staff use the following instruments to screen and assess program participants:
- Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT)
- American Society of Addiction Medicine (ASAM) Assessment
- Patient-Centered Assessment Method (PCAM)
- Behavioral health assessment
While OPCS staff currently use the VI-SPDAT, they and Pima County are undertaking a process to revamp their housing prioritization process. Seeking to emulate the success of the Austin Prioritization Index, partners are working locally to center housing prioritization on equity and in partnership with people who have previously experienced homelessness.