Formerly homeless clients find services lacking

by Jordan Green

An important development has transpired among Guilford County’s poorest residents over the past nine months: People who once slept in tents in the woods, curled up on church porches at night or took advantage of spare couches until friends withdrew the welcome mat are now living in their own apartments.

Three agencies — Family Service of the Piedmont and Greensboro Housing Coalition in Greensboro, and Open Door Ministries in High Point — have been responsible for placing formerly homeless people in apartments, and their housing support team coordinators have won rave reviews from the clients. The program is based on a harm reduction model: Stabilize the client by getting a roof over their head, and then address the challenges that put them on the street in the first place: alcoholism, addiction, mental illness, disability, lack of employability and the like. An array of secondary agencies — private providers endorsed by Guilford Center for Behavioral Health and Disability Services, and compensated by federal Medicaid and state mental health funds — are tasked with providing those additional services to help the formerly homeless clients get their lives on track. Clients report that the support services have been administered in an uneven fashion. In some cases, transportation assistance critical to filling drug prescriptions and getting to food banks and job sites has not transpired. Clients have found no one at the other end of emergency crisis lines in some instances. In other cases, clients say providers have been unable to tell them what treatment they might need. Some of the agencies have been placed in corrective action for failing to provide appropriate treatment, while others have nearly lost their endorsements for failing to meet new state requirements for a certain percentage of services to be provided by qualified professionals. “They are supposed to be helping us do things,” said Reid James, an RHA Health Services client and recovering addict who lives in the Dixie Building across the street from NewBridge Bank Park in downtown Greensboro. “If we need a ride to go get our medicine, they should give us a bus pass or take us there, but they don’t. At the same time they expect us to make sure the prescriptions are filled, but they don’t give us the transportation to do that.” Mike Rhoades, the chief operating officer for subsidiary RHA Behavioral Health said service providers are not allowed to bill transportation expenses to Medicaid. “Our job is to help the consumer become self supportive, help them use the public transportation system, and help them build networks with friends and family to get rides to where they need to go,” he said. “We’re a training provider, not a taxi provider, and that is a common misperception.” Rhoades said he was sympathetic to clients who are unable to reach job sites far from public transportation routes or find themselves short on cash for bus fares. “That is a huge need in many communities in North Carolina — lack of transportation access,” he said. “This is a short-term service. We’ll be gone in three to five months. I would hate for them to get a job based on our ability to drive them to a job, and then we leave and they don’t have a way to get there.” Marc Graham, a 46-year-old formerly homeless ex-marine and RHA Health Services client, concurred that the agency has failed to provide transportation for doctor’s visits and food pantry runs. Moreover, he said that after an initial meeting with his caseworker at RHA

Health Services he remains unclear about exactly what services the agency offers at all. “It’s going on three weeks and I still haven’t heard back from him,” Graham said. “I’m sure they’re billing my Medicaid card. I called them and they tell me they don’t provide transportation. No hard feelings. I’m just going to stop my Medicaid card and tell them to cut it off.” Lee Kallam, a formerly homeless recovering alcoholic, also 46, has already dropped RHA Health Services. “I had no idea what they were supposed to do,” he said. “I could never figure out what they were supposed to do…. The guy at RHA just didn’t do nothing.”Rhoades said he was not aware of any complaints against RHA, but wouldbe open to investigating any concerns brought to the company’sattention. Andrew Kristel, a housing support team coordinator with Greensboro Housing Coalition, echoed some of the clients’ concerns. “It’sbeen a bit of a bumpy road so far with the service providers,” he said,adding that he and other housing support team coordinators have metwith service providers to prod them to meet their commitments to theclients. Transportation to doctor’s offices, food banks andjobsites is a regular if unremarkable need; a reassuring voice at theother end of a phone line during a moment of personal distress can bemore critical. “At one point, one of the providers’ emergencynumbers did not have anybody at the other end of the line for weeks onend,” said Kristel, who did not single out any agency in particular.“If they have a mental disability and they don’t have anybody to talkto, they could be having a mental breakdown, a meltdown. If there’s notanybody at that number, it could keep them from receiving the aid thatthey need to keep themselves together.” One housing supportclient with a history of crack cocaine use who asked not to beidentified because his overall experience with service provider AllStars Group of Greensboro has been positive said that on one or twooccasions he tried to call a crisis line over the weekend and got anoutgoing message instructing him to call back during business hoursfrom Monday through Friday rather than a live human voice. Mitch McGee,a housing support coordinator with Family Service of the Piedmont,confirmed that crisis lines should be staffed 24 hours a day and sevendays a week. Calls to All Stars Group requesting comment for this storywere not returned. Kristel also corroborated another deficithighlighted by clients. “There have at times been issues with theproviders getting people their medicines on time, which is similar tothe emergency-number situation,” he said. “It could send somebody intoa tailspin.” The uneven provision of services in the housing support program, a state pilot program in Guilford County, is emblematic of a larger crisis in North Carolina’smental health system, which was privatized in early 2007 as a result oflegislative reforms initiated some five years earlier. “You have shredded the safety net,” said Republican state Auditor Les Merritt.“I’m sort of a private-enterprise guy, but there’s certain thingsyou’ve got to have government do. You’ve got to provide some basicservices to the most vulnerable citizens. You don’t get much morevulnerable than mental health patients. What happens when you don’t have those basic services is you end up in jailor in the emergency room. “That’s a long way of saying that you’renever going to have private enterprises look after the needs of themost vulnerable citizens,” he continued. “They cherry picked.They were giving some patients far more services than they reallyneeded. That’s the ones they could make money on. They had certain onesthat required far more services than the [Medicaid and state mentalhealth funding] rates reimbursed for, and those were the ones thatdidn’t get the care they needed.” In May 2007, the NCDepartment of Health and Human Services and so-called local managemententities — former county mental health departments that now function asa sort of mid-level regulatory and technical advisory agency — beganconducting post-payment reviews for community support clients who werereceiving in excess of an average of 12 hours of service per week. Thestate ordered the Guilford Center to review 236 consumer files todetermine whether agencies provided appropriate clinical interventionand treatment. A review by YES! Weekly found that 34agencies were ordered to submit corrective action plans and 26 weresubjected to further audits by the Guilford Center, while 24 agencieswere referred to the NC Division of Medical Assistance forinvestigation. One review of the Voca Corporation, a company set up inJamestown by officers with listed addresses in Kentucky and Georgia,uncovered a 92.3 percent failure rate. In other words, the localmanagement entity’s review of one of the agency’s invoices found thatin 12 out of 13 criteria the agency did not provide appropriateclinical intervention and treatment to a client. Wes Root with theGuilford Center said Voca Corp. no longer provides community supportservices in the county. In April 2008, the NC Department ofHealth and Human Services announced it had received notice that thefederal Center for Medicare and Medicaid Services would defer paymentfor community support mental health services — an amount calculated bythe Division of Medical Assistance at $137 million — “until the federalagency is satisfied that abuses are no longer occurring in theprogram.” “There were lots of paybacks from the providercommunity,” said Susan Campbell, manager of access and care managementat the Guilford Center. At least two agencies used by clients of the housing support program in Guilford County were flagged during

theGuilford Centers’ post-payment reviews in the summer of 2007. One wasAsheville based RHA Health Services, an agency used by James and Grahamthat serves clients across North Carolina and Tennessee. Anotherwas Star Care, the agency chosen by Kallam after he dropped RHA HealthServices. “Those infractions had to do with the way we were documentingour services not related to the way we were providing the servicesthemselves,” said Rhoades of RHA Behavioral Health. A teamfrom the Guilford Center visited the company’s High Point office anddetermined that it had satisfactorily corrected its deficiencies, Rootsaid. Of the 34 agencies flagged by the local management entity, StarCare is the only one still serving clients in Guilford County that hasnot completed its corrective action plan. Root said the Guilford Centerhas an agency site visit scheduled for this week. Administrator MartinaUkattah said Star Care is prepared for the local management entity’svisit. “The service definitions were not defined for theproviders,” she said. “For us to be in line with the servicedefinitions, we have to know what they are. [Root] said they had a plancoming out. They keep changing on the service providers.” Whilesome agencies have struggled to get out of corrective action, othershave found their endorsements in jeopardy because of difficulty meetingnew state requirements mandating that at least 25 percent of billablehours be provided by someone considered to be a “qualifiedprofessional.” Phoenix-based Recovery Innovations of North Carolina,an agency that operates its local office out of the same county-ownedbuilding that houses the Guilford Center, was notified on Aug. 13 thatits endorsement for adult community support services was beingwithdrawn. Jamestown-based Family Service of the Piedmont receivednotice the same day. Both agencies successfully appealed, and had theirendorsements were restored on Sept. 8. Recovery Innovations was thefirst of a succession of service providers used by James. “Thepsychologist, she’s having some personal problems; she was way out ofline,” said James, who is in the process of applying for disabilitybenefits from the Social Security Administration for a degenerativecondition that she contends preceded her alcohol and substance abuse.“She said, ‘I think you’re being lazy, and you don’t really want tofind a job.’ She also had been under a lot of stress because herhusband has untreatable cancer, so I can understand.” Chroniclung problems, asthma, degenerative cervical vertebrae that makes herright arm go numb, degenerative arthritis affecting her left shoulderand a host of other health problems have so far proven to beinsurmountable hurdles in James’ search for gainful employment. “Thecase manager, she didn’t know about half the resources I do,” Jamescontinued. “She didn’t put her heart into it. I said, ‘Screw this: Thisis going absolutely freaking nowhere.’” Phone messages toRecovery Innovations were not returned. James’ housing support teamcoordinator is Mitch McGee, with Family Service. Following her disappointing experience with Recovery Innovations, she also signed up with Family Service for enhanced services. “FamilyService did hook me up with a talk therapist, but for some reason theydidn’t continue that,” James said. “They hooked me up with asubstance-abuse therapist, but they’re not sure that’s where I’msupposed to be. Today, I’m literally sitting in limbo right now.”Family Service of the Piedmont interim President/CEO Tom Campbell saidthe agency’s policy is to transfer client data at the serviceprovider’s request on condition that the client signs all appropriatereleases. Notwithstanding Family Service’s handling of James’substance abuse problems and alleged failure to provide continuity asshe transitioned to RHA, the client lavishes praise on McGee, whocontinues to serve as her housing support team coordinator. “Mitchhas been the best resource of any that I have had,” James said. “Hewill take care of you. He will make sure you’ve got your phone billpaid. He gave us rides to the Hive over the summer on Fridays to getfruit and vegetables. “They paid for dental work,” shecontinued. “That was Mitch McGee. He just said, ‘Get a receipt and I’llcover it.’ Right now, I’m sitting here with an empty socket where mytooth was, but it’s a lot better than having an exposed nerve.” Other clients have also credited their housing support team coordinators with helping them get their lives back on track. Stillothers have said they are not bothered by the uneven performance ofsupport providers because they have enough self reliance to seek outresources such as Alcoholics Anonymous meetings on their own. “It makesit really hard for these private providers to survive because they’regoing to have their qualified professionals working crazy hours,” saidKristel of Greensboro Housing Coalition, “or they won’t be able to meettheir QP requirements and thus they’ll get dissolved.”

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