Alcohol is widely available and relatively inexpensive, making it one of the most commonly abused substances within the homeless population, notes the National Coalition for the Homeless. The National Healthcare for the Homeless Council estimates that up to half of single homeless adults have abused alcohol, while up to a third abuse other drugs.
The most common treatment options available for substance abuse are:
? Inpatient residential treatment
? Outpatient treatment
? Group therapy
? Private/individual therapy
These forms of treatment differ in terms of cost, time commitment, and availability/accessibility. While these options can be effective, their associated costs and locations may present significant challenges for most people and may even be perceived as insurmountable for the homeless. For example, the homeless needing treatment often lack insurance which can cover the high cost of treatment. Without insurance, the out-of-pocket costs can make treatment untenable including even the lower-cost options such as outpatient and individual therapy.
The Office of Housing and Community Services had been exploring alternatives to traditional addiction treatment as it continued to encounter difficulties in connecting its homeless clients to conventional treattment. Miami Beach Community Health Center (MBCHC), a federally qualified health care center serving our city, often sees the same population through its multiple community clinics. The city and MBCHC staff explored the challenges connecting clients to treatment and focused on medical approaches to tackle the problem including the use of pharmaceutical options that block the effects of opioid and alcohol use.
There are currently several medications in the marketplace that are designed to prevent relapse to opioid dependence after detoxification and to treat alcohol dependence. These medications should be used in conjunction with drug or alcohol recovery programs such as counseling. As with all prescription medications, these medications are intended for persons who receive screening for appropriateness by a medical practitioner (as they may not work for everyone).
As proposed, the city will refer homeless clients who express an interest in addiction services to Miami Beach Community Health Center for a health screening. If the client is deemed a good candidate for the approach, MBCHC will provide the medication and follow-up care at Miami Rescue Mission and its multiple clinic locations in Miami Beach and North Miami. The city will continue to provide care coordination and additional supports including: ID replacement, housing referrals, security deposit for independent housing (when the client is stabilized and as funds allow), and ongoing shelter services during the duration of stabilizing treatment.
This approach provides accessible treatment when the client is ready to accept services and establishes the supports and wraparound services to ensure that the client hits the ground running as he pursues employment and community reintegration. Importantly, the service connection with MBCHC can continue when the client obtains housing as services are not contingent on the client’s homeless status and can continue after the client has obtained stabilized employment and housing. During this pilot phase of the program, only men will be served. If the pilot is deemed effective, the city and MBCHC will explore expanding service locations and client reach to include women. As with all services provided by MBCHC, the Agency for Health Care Administration (AHCA) must provide approval for service expansion. MBCHC has received this approval for the pilot program and will be reporting back to AHCA as the program evolves as this model may offer a replicable solution for other communities throughout the United States.
The pilot will last for about one year to enable assessment. Medication and services costs (which vary by patient) will be covered by MBCHC for those pateints without insurance. For those with insurance, eligible costs will be charged to the insurance companies as appropriate by MBCHC. As a reminder, MBCHC is a federally qualified health care center providing sliding scale and no cost health services. Program success will be measured by the number of clients who complete their treatment plans, obtain employment (or disability benefits) and transition to permanent housing. Staff will also be tracking those who continue treatment but transition to alternate housing while participating in the program. Hopefully, the program will offer relief to those facing addiction but who cannot access traditional treatment programs such as in-patient rehabilitation.