Northlands Rescue Mission: Dave Sena said they provide furniture; medication monitoring in terms of securing and logging meds so others don’t have access (for safety, not compliance – they don’t require a resident to take their meds). Gerri Anderson suggested differentiating on the matrix that there are different types of meds monitoring; i.e., did you take what you should vs. securing and locking up for safety. Dave said they do have a few people who have been there awhile, so they think of themselves as an emergency shelter and transitional housing. They have been rep payees sporadically in the past. They help their residents get placed in jobs and also have some residents who work at the Mission, i.e., train in the kitchen so they can get similar work elsewhere. They also follow up when someone applies for a job. They have a van and do transportation both for jobs and medical appointments. They ask residents to pay for transportation if they can afford it. They also provide recreational opportunities. Entry is by walk in or referrals including discharge referral (jail, etc.). Clients exit if they violate rules mainly with substance abuse or violence or if they have an extreme medical condition.

Red River Valley Community Action (RRVCA): Lora Machart said they have a program called “food fellowship” which is recovery and distribution of day-old food. They also provide commodities as well (food pantry-type services). They operate permanent supportive housing and Shelter Plus Care with in-home visits. They provide money management and budgeting services. Entry is through income eligibility via application. They also have a weatherization program and recipients must income qualify. Clients receiving emergency one-time services exit when that service has been completed. Otherwise, clients exit if they are in non-compliance or if they successfully complete their program.

Other services provided: Salvation Army provides food, clothing, and furniture. Salvation Army, Prairie Harvest, and St. Vincent de Paul are community-wide thrift stores open to the public. Both St. Vincent de Paul and Salvation Army provide emergency crisis services. RRVCA does apartment and day care deposits. United Way does Undies Sunday and distributes donations to agencies. Centre Inc. provides limited housing with meals provided and SA treatment is available by referral from NE. Centre also offers psych services, med monitoring and has “crisis” beds but they are not necessarily an emergency shelter. Crisis residence is for people someone coming out of treatment who need a place to live until they are done with treatment. Jessica felt this could be considered transitional housing. Mountainbrooke provides support groups, food pantry services for clients, daily meals and social activities. Entry is by walk-in but clients must have mental health issues. Clients exit if they are violent, intoxicated, or violate the site rules. Under health care, there is no social detox. Addiction treatment is available through Drake in Grand Forks (private provider). NE is the only inpatient provider of SA. Altru does medical detox. Terry suggesting adding Third Street Clinic to the list of medical providers, as well as the new dental clinic and Valley Community Health Care in Larimore and Northwood. Jessica added UND Counseling Center under mental health as well as the Psych Service Center at UND, which has a sliding fee scale. Northland Christian Counseling Center and Village Family Services were also added. Meds or med funding is provided by St. Vincent de Paul, Third Street Clinic, NE (have samples available), and Altru Community Prescriptions Services.

Altru provides inpatient psychiatric services as well as the Stadter Center if you have insurance or other resources. Under emergency shelter – we have shelter for adults, men and women separately, and women and children who are victims of domestic violence; however, we have a gap in our emergency shelter for men with children or for two-parent families. JoAnn Brundin said they receive requests for shelter for two-parent families with children a couple of times a month, which is quite often. Terry expressed an idea for a possible solution - if the Housing Authority has available empty units and doesn’t have anyone scheduled to rent them for a week or so, they could possibly be used for emergency shelter. Gerri Anderson said NE could help with providing furniture. Terry said if chronically homeless people are given a priority, then they can obtain a voucher and then stay in the apartment.

Job training is provided by Development Homes and Success Unlimited. The Social Security Administration has strict regulations about who is allowed to be a rep payee, although Village Family Services has provided this service in the past through Personal Money Management out of Crookston. Prairie Harvest also does some rep payee for non-NE clients. Jessica said it is difficult to become a rep payee so the service exists, but it is not readily available. Education is provided through GF School District for GED and from the Adult Learning Center. Every agency does limited money management for their clients; Prairie Harvest offers classes. JoAnn Brundin suggested adding Success Unlimited under job placement and job coaching. Minot Vocational Adjustment Contract provides janitorial services out at the Air Base through Voc Rehab. Lutheran Social Services provides counseling for youth who are in or at risk of becoming involved in the juvenile court system. Options provides advocacy and support for people with disabilities. LISTEN provides recreational activities for disabled adults.

After a break, Jessica said it appears that most services are available except for social detox. Services readily available to homeless people are mostly basic needs and health care. Limited success is achieved if you have to transport someone out of the community in order for them to receive SA treatment. Mental health counseling is available to someone in crisis but seeing a doctor could take longer. Jessica asked if LTH clients were accessing mental health services. Gerri said some were, but JoAnn felt most weren’t and that’s part of the reason they are homeless. Dave agreed that it’s hard to get clients seen, not because of NE, but because it is hard to get the client to relinquish control or to even get their medical records.

The committee discussed substance abuse treatment availability. Eliot asked, if you have no new money, how many new patients could you take and how much treatment could they get. Gerri Anderson said capacity is an issue – there are waiting lists. NE has two addiction counselors that do day treatment with larger groups of 10-15. There are only a limited number of beds at Cornerstone. As far as priorities, there are some federal requirements (pregnant and using, etc.). The biggest barrier is people who aren’t ready to sober up yet and get treatment. JoAnn asked how long they have to wait if they are ready. Gerri replied there is no priority right now. Terry asked if enough funding was available, would there be a waiting list and Gerri replied probably not. Jessica said we need to figure out what the incremental cost is of adding treatment for another 10-15 people. Gerri said another problem is that it’s hard to find licensed addiction counselors. Jessica agreed that she has heard this statewide, as well as a shortage of mental health professionals. Terry wondered if the State could put out an RFP for licensed addiction or mental health professionals. Eliot asked about UND’s capacity for providing substance abuse counselors; i.e., is anyone in training, could they have an internship program that provides for the needs of this group? Eliot suggested having a pilot program that provides services for 15 people and track them for 2 years. Dave felt the number was higher than 15 or 25 and Jessica agreed that the PIT was an imperfect measure, but if you count 25, then double it and you might come closer to the actual number.

Jessica reiterated that rep payee services were not readily available. Many agencies were already providing transportation, either with tokens, tickets, or rides. In-home visits and support were provided by Prairie Harvest and the Village. CVIC and St. Vincent de Paul provide transitional housing. Mostly, if a client is affiliated with an agency, then the agency provides in-home services.

Jessica moved on to the Strategic Framework and started a discussion on #3 – Foster trust to enable effective outreach. She asked about integrating peer counseling into program delivery and engaging volunteer mentors for homeless who are in permanent housing. She asked who is doing peer counseling now and do we want to have this as part of our plan. Dave said they are working with volunteers who have been trained specifically for people getting out of the Mission. Gerri said the issues this particular group of people has are pretty intense, so once they get stabilized, peer counseling might prove helpful; however, working with and training peers takes time. Prairie Harvest has a lodge program that is peer supported. Meredith Richards referred to the videos we have seen where the person doing the intake says “I have been in your shoes”. First we need to create success stories of people who have made the transition and then they can become part of that system as the program is delivered. Jessica said “peer support” might be a better phrase; they are a member of the team but not a counselor. Terry said whoever mans the front desk at the emergency shelter or 24/hour service could encourage clients - if we help you, you help others. Gerri said, speaking for an agency, a big issue to consider is what is the liability; we would need to do background checks because they would be working with a very vulnerable population. Jessica said continuing to foster trust and build relationships is very important.

#4 – Coordinate services to provide rapid access and individualized treatment – Jessica asked about the possibility of implementing a preference system. Terry said this was necessary if we want to end chronic homeless. Jessica said that sometimes the wait itself is a barrier to this population (long time without stable housing). Gerri added that sometimes people use the wait as an excuse. Jessica said that possible solutions under this category would be to create a housing placement/outreach position at Northlands Rescue Mission or revive the crisis intervention team. If 80-90% of homeless people are housed at the Mission, it makes sense to go where they are living; perhaps we could coordinate a “virtual” crisis team; i.e., a group of key contacts who have the authority to act. Meredith agreed that a preference would go a long way to making that practical. Jessica said, if we are trying to move people out of emergency shelter (if a measure of success is fewer people staying at the Mission long term), then the services they receive at the Mission should follow them to their new home. Meredith asked if this could be added to someone’s workload rather than adding a new position; i.e., use existing providers to create a focus person. JoAnn suggested having a crisis team meet regularly (i.e., twice a month) at the Mission in order to have the whole team there. Dave felt that a “virtual” team, where you pick up the phone and call key people, also might work - don’t hang your hat on twice-monthly meetings if you need to act quicker. Gerri said NE started off providing outreach at the Mission but, over time, they have been eased out of this.

Jessica said, even if we assume we have housing taken care of, we haven’t come to a consensus on how to support people in housing so they don’t fail. How do we support people in apartments but are not in a program per se? Eliot said he liked the idea of a case manager with connections to all the other services in charge of 15-25 people a year. This allows you to build trust. We need identity, purpose, and numerical identification. With CDBG funds, we should be able to find money to pay the salary for an identified person to make sure support services are there. JoAnn wondered if all the agencies wanted to come together and apply for dollars for a shared case manager to make sure all clients stay in permanent housing. Meredith asked who the case manager would work for. Dave said he would like that responsibility because the Mission is where most of this population goes. Jessica said we need to be aware of the issue of duplication of services; maybe have one service with multiple areas of access. The biggest strength that Grand Forks has is it’s providers and how connected and experienced they are. Gerri said, in dealing with a difficult population with specific needs, there has to be a certain amount of expertise so that there is true intervention going on. Terry asked if we were talking about a counselor or a coordinator. Jessica said we need the support around someone in housing, rather than someone in a particular service. It depends on the trust relationship – what is their comfort point. JoAnn asked if each agency could afford to do its own case management for people they place into permanent housing. Dave said, at the Mission, they quite simply don’t have enough time to follow their clients once they leave, so he would like to see actual position created. JoAnn said St. Vincent de Paul has fewer clients than the Mission, so they can do follow up on their clients; but agreed that the Mission has higher number so they might not have time to do follow up. Dave said, right now, they are just trying to cope with keeping people housed and fed. JoAnn asked how many people per month could the Mission place into housing if staff and funds were both available. Dave said that was a good question - probably about 25-30. They have clients who have lived there for years because it’s low rent housing; they are now starting to work getting those people moved out of the Mission. Terry said they could either move them out or make the top two floors of the Mission into permanent housing. Dave said they just haven’t had the staff available to talk with every client about the goal of getting into permanent housing. JoAnn said making some rooms at the Mission into permanent housing would do two things (1) exclude those tenants from the homeless count; and (2) enable the Mission to apply for Section 8 Vouchers because they are providing permanent housing. Terry said a unit needs to be at least an efficiency apartment in order to qualify for a voucher. Terry wondered if we want to integrate people more out into the community so even if they are living in an assisted unit, they are actually blended in with the rest of the community. Dave replied there are some of his clients that would like permanent housing outside of the Mission, but there are other clients with mental illness problems where it may not work so well. Gerri said, in doing her job in providing support, she is actually trying to work herself out of a job by trying to get her clients to move along into the community. Keith Berger felt that finances are tough enough at the Mission, so sometimes long term clients provide the funds to keep their doors open. If they move out of the Mission, we will have to backfill dollars to the Mission to keep them open. JoAnn added that there are also some people that are better housed at the Mission in order to keep the community safe.

#7 – Ensure an adequate supply of permanent, affordable housing. Jessica said, in talking about SRO or efficiency apartments, maybe there is a chance for the Mission to co-develop, along with the Housing Authority, this kind of facility to reduce financial problems caused by long-term residents moving out. Keith suggested using the old GF County office building for SRO apartments that could qualify for housing assistance, adding that it would take a large amount of rehab dollars up front. Dave said, in talking with his board, they are looking at a re-entry program for their clients to get into housing and support services. Dave said the Mission is running out of space. Ideally, he would like to get women residents out to another space and only house men at the Mission; with long term men residents at yet another facility, and maybe families at another facility. JoAnn said maybe we could start a pilot program and meet at the Mission just to see how this would work. Meredith said this starts developing the trust relationship which is important; that’s why the Mission is successful with certain people because they do just that. Maybe it takes a team going there for a couple of months so people can begin to develop trust in order to participate. We would be showing willingness or openness to the clients; i.e., we want to talk to you in your comfort zone. Geri added, if providers are there to offer services on a regular basis, people are more apt to sign up (i.e., today we’re going to sign you up for housing, today we’re going to fill out social security forms, etc.). Jessica said we need to make sure housing placement outreach is a primary focus with each agency (whether you follow your own clients into permanent housing or have a team of people to do this). This could include key providers getting together to make things happen. Gerri asked if we can access Shelter Plus Care without the Continuum of Care and Jessica replied no, that each application needs to go through the CoC process. Jessica said we can use Section 8 Vouchers for the majority and Shelter Plus Care for cases that require individualized access rules. Terry said the Housing Authority could apply for Shelter plus Care vouchers but we need other agencies to provide services in order to apply. JoAnn said this is something we need to pursue and asked Terry to chair this meeting and invite agencies to attend. Terry said the next step for someone at the Mission is an independent living facility. Then, to get Shelter Plus Care dollars, we need a commitment from agencies for services, which would then be available at the tenant’s choice. Jessica added, when talking about SRO’s, ideally we wouldn’t limit it to LTH, but rather focus on creating affordable efficiencies. Terry said we could also think about the old Deaconess Hospital which is across the street from the old County office building. Terry said he envisions providing a building that is manned 24/7 so when an individual is ready, they have a place to go and someone to talk to. A staff person would be a resident service coordinator who would have contacts to each agency to say this person is ready right now and then the specific agency would have the authority to provide services right now. Jessica felt that an SRO would be a large part of the recommendations coming out of this plan. To increase the amount of rent subsidy we can provide, we need to apply for more S + C vouchers, plus we need to coordinate efforts to link homeless individuals with financial benefits. Jessica reported that there is a Social Security initiative right now to enable or enhance access to SS benefits.

Jessica asked if we should include a recommendation for a social detox and Dave felt we should. Terry said an effort to this end is currently underway in the community. Eliot added that funding will be a challenge. Jessica asked if it would be safe to say we need to increase our local capacity for inpatient treatment for Substance Abuse, adding that a cost analysis from Altru, NE, and Centre would help prove this need. We could partner with UND to identify Licensed Addiction Counselors, which is a statewide issue much like landlord mediation issues. Dave wondered if we are having a hard time recruiting people to this location. Terry suggested asking UND to implement a commitment for residency for a certain number of years or increase the number of internships. Jessica agreed that UND is uniquely positioned to do this with the Social Work and Medical School departments. Eliot added that the UND Community Engagement Center is poised to identify community needs and find community solutions. Eliot agreed that we need to involve UND in our solutions.

Jessica said she will get a draft plan out to everyone and added that we will probably need to get together one more time to review the plan. Then it will be time to take this to the City Council for a working session, and for adoption. Jessica thanked everyone for attending and for their comments. The meeting adjourned at 5pm.