2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Housing and Employment: Key Components of Behavioral Health Reform

Housing is one of the most important recovery supports for many people who struggle with substance use disorder. There is also a very strong link between recovery from substance use disorder and economic self-sufficiency, including employment. These two support services very often go hand in hand.  OASAS is committed to the care, recovery and sustained well-being of individuals with substance use disorders.

Housing

OASAS has long valued the need for adequate housing – be it affordable, transitional, or supportive. OASAS has had a long history of providing housing for those suffering from substance use disorder. From the first medically monitored crisis services in 1978 to temporary shelter services to supportive housing, OASAS has long offered a diverse and creative housing portfolio.

OASAS’ permanent supportive housing initiative has its roots with the HUD Shelter Plus Care program that began in the early 1990’s. By the mid-2000’s, other housing programs began to emerge: New York New York III Singles; NY/NY III Families; Re-entry; Upstate Permanent Supportive Housing; and most recently, MRT Housing. Today, OASAS offers more than 1,800 units of permanent supportive housing through six programs supported by a nearly $30 million budget derived from federal and state resources.

OASAS’ commitment to permanent supportive housing stands out because of its commitment to families and its programmatic link to each rental unit to include case management and other necessary support services. Tenants after one year in permanent supportive housing have high rates of long-term retention, enrollment in school, and employment.

Most recently as part of Governor Cuomo’s Medicaid Redesign Team (MRT) efforts, an Affordable Housing Workgroup was created. The MRT initiative has helped shift the perception of housing from an ancillary service to one where it is accepted as an invaluable part of a long-term strategy to improve health care.

In New York State many systemic changes are occurring simultaneously. Behavioral Health Organizations (BHO’s) and Health Homes have taken their place in shaping care for Medicaid recipients, and we will ask the Centers for Medicare & Medicaid Services (CMS) to allow New York State to supplement our efforts through the development of new 1915(i)-like home and community-based services.

Peer recovery coaches and residential supports for those who meet functional need criteria to meet independent living are taking their place in the behavioral health system. Success for all these dynamic changes will not be possible without permanent supportive housing being available.

Additionally, OASAS is embarking on a plan to redesign its residential system. The plan calls for the current Intensive Residential, Community Residential, Supportive Living and Medically Monitored modalities to be redesigned into a residential model comprised of three phases of care: stabilization, rehabilitation, and reintegration.

This new model will be patient-centered and recovery-oriented by matching patients to the phase of care that best meets their needs.   It will focus on goal attainment and moving people towards community re-integration. Permanent supportive housing must be available for this redesign to be successful.

Based on the strong foundation established by the above efforts, OASAS is poised to assist the state in meeting the triple-aim for Medicaid Redesign: better care; better health; and, lower costs.

Employment

Along with permanent supportive housing, employment ultimately benefits the recovering individual, his or her family, the employer, and the community at large. Research demonstrates that an important outcome indicator in the substance use disorder recovery process is the individual’s ability to successfully obtain, maintain, and/or reintegrate into the workplace.

It is critical to treatment and the recovery process for OASAS treatment programs to integrate comprehensive vocational rehabilitation (VR) counseling and supported employment as evidence-based practices that also support improved treatment outcomes for people recovering from substance use disorders.

In 2013, OASAS oversaw a nearly $10 million budget providing employment support services statewide for individuals in our treatment system. While that is significant, we must continue to work with other agencies whose primary function is to provide employment services.

Since the 1980’s, OASAS has had an ongoing collaborative working relationship with the New York State Education Department’s Adult Career and Continuing Education Services – Vocational Rehabilitation (ACCES-VR) and the state Department of Labor, that work hand in hand with OASAS to assure positive employment outcomes for people in recovery.

In New York City, OASAS works closely with the Association of Vocational Rehabilitation in Alcoholism and Substance Abuse (AVRASA).  AVRASA’s relationship with OASAS dates back to the 1980’s and includes a membership of approximately 250 vocational rehabilitation counselors and employment specialists. Presently, OASAS is working with AVRASA towards expanding their VR counseling support to Long Island and the upstate region.

We at OASAS are committed to our mission of helping all New Yorkers improve their lives and shape a future where all can reach their potential. Supports for permanent supportive housing and employment are two important strategies for achieving this goal.

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