Discharge Planning Group Meeting Minutes – 2/10/11

In attendance:  Nick Albano, Hampden County Sheriff’s office, Elissa Burdick, CSO Florence Crisis/Respite, Vuthy Chhum, Hampshire Sheriff Office, Carl Cignoni, Hampshire Sheriff Office, Jason Cuyler, Berkshire County House of Correction, Danielle DeBerry, ServiceNet, Barbara Diamond, Cooley Dickinson Hospital, Karen Dean, Hampden County Sherriff Dept., Olga Ellis, City of Springfield, Michelle Engel, Hampshire Sheriff Office, Susan Fortin, DMH, Whitney Hopwood, Hampshire Sheriff Office, Jessica Galligan, MA Department of Corrections, David Gadaire, Career Point, Janice Humason, Friends of the Homeless, Rose Knapik, Cooley Dickinson Hospital, Francis LaGace, DMH, Dave Modzelewski, Mental Health Association, Timothy Mullen, Hampshire Sheriff office, Maureen Normand, Eliot CHS Homeless Services, Tony Pereira, Carson Center, Claudia Phillips, Mercy Medical Center, Health Care for the Homeless, Martin Pope, Baystate Medical Center, Jerry Ray, Mental Health Association, Pamela Schwartz, network coordinator, Jo-Ann Tolliver, Northampton VA, Laura Waskiewicz, Franklin County Sheriff Office, Kevin Weir, MBHP, Margie Westwell, ServiceNet/Hampshire Sheriff, Kurt Zellen, Northampton VA.

Feedback on Quick Referral list:

Claudia Phillips, Health Care for the Homeless, suggests getting info direct from facilities to HCH (instead of shelter to HCH) – will get better info that way.  Examples of questions to answer:

If being discharged on med, does patient have ability to obtain medication?
Does patient have ability to follow medication regime?
Discharging agency should be specific about medication follow-up.
If psycho/social concerns have come up during in-patient stay, it would be helpful to have that information.

Best contacts:  Mercy: 413-748-9064
clinic after hours, 413-734-7140

Nurse care manager at CDH, Rose Knapik:  since being part of this discharge planning effort  and learning about CSP workers, she has been able to connect to CSP staff; it has been very helpful in making connections to meet needs.

Agency/Institution Reports:

State DOC , Jessica Galligan:

DOC release planning:  begins  6 months in advance of release date – identify then if at risk of homelessness; if so, begin a housing search; last resort is a shelter.  First looking at residential programs, rooming houses.  15% of overall releases stateweide go to W. Mass. – 195 inmates since July returned here.  154 returned to housing.  2 inmates went to hotel/motel; 2 to rooming house; 14 to residential program; 10 went to sober house; 13 to shelter (largely veteran releases).  One person at each state facility is a designated  housing search specialist.  88% of all inmates have approved Mass Health insurance.

Moving towards housing specialists focusing by region.  Because W. Mass. doesn’t have a state corrections facility here, DOC is reaching out to Shirley  facility housing specialist.  Discussed connecting this person to Western Mass. Interagency Council (WMIC).

Dave M:  for those inmates returning to a home, frequently that housing is short-lived and homelessness occurs not long after.

DOC confirms housing arrangement stated by inmates.

Carl Cignoni, Hampshire County Sheriff :  Parole will not release with confirming housing.

Barbara Diamond, DMH – faced with a level 3 sex offender who needed rehab care and came up against state law that prohibits nursing homes from admitting level  3 sex offenders

Kurt  Zellen, VA:   Many veterans do not realize they are eligible for veterans.  Must be sure to ask:  Have you ever served in the U.S. military?

Hampden County Sheriff’s Office:

Karen Dean – runs drop-in center, offers education, employment, mentorship, serves over 2,000 individuals yearly, have new initiatives coming out, Access to Recovery, via DPH, will provide additional services to individuals in recovery.  All releases through pre-release go through center.  Goal within 6 months is for all releases to go through after care.  Work with 200 agencies in the region.  Housing specialist for sheriff’s department.    Runs a 50 bed program called Foundation House.  Have new initiative – 10 bed permanent housing for individuals.

Nick Albano:  works “inside” – has one person working with half-way houses.  Inmates in crisis when discover they are homeless.  Drop-in center is critical.  Needs a place in community where person can connect.

Dave M:  DMH began forensics program to address people coming out of jail, going to shelter, since recidivism rate is 100% within 30-60 days.  Would love to expand this program.  Need safe and affordable housing, need strong housing stabilization service; need continued connection to corrections, whether through parole, probation or day reporting.  Those things in combination can keep people housed in community.  Then it’s time to look at employment opportunities.

Hampshire County Sheriff’s Office:

Carl Cignoni:  start release planning as soon as they come into institution.  First question is:  do you have a place to stay when you’re released?  Alerted at the start if at risk of homelessness.  Will work with people on housing and treatment plans.  Sentences are fairly short, up to 2.5 years.  45 state inmates at facility.

If no job, no money, resistant to half-way house, makes it very difficult to find housing.  Sometimes a voucher through Salvation Army to get one month’s stay in a room.  About 1 or 2 people a month released are at risk of homelessness.  Make referrals to ServiceNet.  If no place to go, they try hard to get them into a halfway house.

For mental health issues – will make referrals to DMH and try to initiate housing.

Sometimes face resistance from individuals – they want to go out into the woods.  Try to convince of other options, but sometimes doesn’t work.

During pre-trial, sometimes defendants are released without meds.  A larger issue that must be addressed.

Franklin County Sheriff’s Office:

Laura Waskiewicz – new sheriff, extremely pro-treatment,  suffered 26 lay-offs in the last 2 years, lost re-entry house, lost other programs.  In process of rebuilding.  Rural area – huge area where 2 or 3 inmates from tiny towns – no resources for drop-in centers in small areas.  Greenfield is county seat and center.  Way to be in touch with inmates is to use case managers on a one-on-one basis.  Intention with new sheriff is to create program and follow inmates for 6 months.  Person from jail needs to follow person out.  No jobs, no public transportation.  Starting a new recovery program but without public transpo very difficult.  Following Hampshire’s model and will develop discharge planning meetings.  Having a meeting with service providers around discharge.  Ask inmates about discharge plans.  Most concerned about need to sign up inmates for insurance – need a “virtual gateway” to get people insurance.  Still need to sign up people and send up forms now – very cumbersome.  Need to partner with orgs who can help sign up people for Mass Health.

Claudia Phillips:  will help connect them!

Also need help getting SS benefits:  Referred to Clare Deucher – Disability Determination Services – 617-654-7458/1-800-882-2040 ext 7458.

Berkshire County House of Correction

Jason Cuyler –  share same issues as Franklin County.  Further west, fewer resources.  Struggling to place people getting out of jail into a safe environment.  3 shelters in 3 different parts of county – Lewiston House, north, Barton Shelter, central, Construct, south.  All 3 shelters work well with jail.  Transportation is very difficult, huge issue.  Use half-way houses.  Re-entry starts from day one.  New sheriff – very invested in re-entry programs.  Jason works with people inside and outside of jail.

REACH meetings could be a good conduit for people to connect.

Dave M:  We now have over 600 housing units dedicated to serving homeless individuals in the 3 counties.  Use housing directory on blog – westernmasshousingfirst.org – to find out more resources.

Friends of the Homeless – interagency meeting  in Springfield –  meets weekly to discuss homeless – contact Janice Humason.

Discussion of this group’s continuity; the utility of cross-county discussion:

There was unanimous agreement that a regional discussion of these issues was valuable and people would like it to continue.  We agreed that we needed to reach out to other agencies that belonged at these meetings – Pamela encouraged all to forward notice of next meeting to those who are missing.  Dave Modzelewski reminded everyone that the Initial impetus to this effort was to address the problem of homeless people turning up at shelters’ doors at the eleventh hour upon release from an institution.; that we need to continue to build this bridge of services that will keep individuals’ safety paramount. We agreed it is useful to come together to identify real gaps and develop a plan to fill them.

All agreed:  Pamela would solicit interested people to participate in a smaller planning group for this large group.  The planning group will meet in March to create an agenda for an April meeting.  Pamela will be in touch with dates.

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