Essential Tools for Discharge Planning

Because Health Care is a Right, Not a Privilege

I. Introduction and Overview

Various public and private institutions contribute to homelessness by discharging their wards to the streets or shelters. Ending such practices is an important, current tactic in the struggle to end homelessness itself.
The National Health Care for the Homeless Council encourages health care providers and other advocates for homeless people to examine the impact of ineffective institutional discharges on homelessness in your own communities and to advocate for policies that will help prevent homelessness.
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To that end, the National Council provides the following materials, which have been compiled for us by the Massachusetts Housing and Shelter Alliance (MHSA). These materials document the remarkable strides made in Massachusetts over the last five years, and provide practical models that are replicable in many communities. The compilation also provides the major documents on the topic from the national level. (For the National Council's own Policy Statement on Discharge Planning, please click here.)
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We are grateful to Mary Ellen Hombs at MHSA for her life's work fighting Discharge planning

homelessness work that includes but far surpasses preparing this set of materials and to Philip Mangano, now the Executive Director of the federal Interagency Council on Homelessness, who developed this good work during his years at MHSA.
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Partial funding for this publication was provided by the Division of Programs for Special Populations, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, through a Cooperative Agreement with the National Health Care for the Homeless Council, Inc.
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Any part of this document may be freely reproduced for educational and training purposes, with appropriate acknowledgement of the National Health Care for the Homeless Council, the Massachusetts Housing and Shelter Alliance and this web site as the source. Reproduction of these materials for sale or profit is expressly prohibited.

I. INTRODUCTION AND OVERVIEW

Overview of the work of the Massachusetts Housing and Shelter Alliance (MHSA) to document the connection between growing homelessness and discharges from public systems of care, to create resources to address the problem, and to develop a comprehensive strategy of homelessness prevention that assures successful discharges to the community.
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II. ASSESSMENT MATERIALS

Examples of quantitative research tools and reports that communities can use to assess the nature of discharge issues locally, ranging from program specific data collection to system-wide analysis.

A. Introduction to Assessment Materials
B. Homeless Shelter Census and Overflow Data Initiative

Summary charts from MHSA’s shelter census initiative and data collection effort focused on discharges from state systems of care and basic how-to information and census forms.

C. Impact of Homelessness and Supported Housing on Health Services and Shelter Utilization

Research presentation prepared by Dr. Dennis Culhane of the University of Pennsylvania to examine the use of publicly funded emergency services by the homeless mentally ill population and the impact on costs of placing individuals in supportive housing.

D. Health Care: Data from the Lives of Homeless People: Morbidity Review of 13 Homeless People who died in Boston, July 1998 - January 1999

A morbidity review conducted by Dr. James O’Connell of the Boston Health Care for the Homeless to determine demographic characteristics, prior service contacts, and conditions of death of homeless people.

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III. COLLABORATING WITH LOCAL STAKEHOLDERS
Strategies used to define the issues in collaboration with local stakeholders.
A. Introduction to Collaborating with Local Stakeholders B. Tools for Convening Conversations with Local Stakeholders
Agenda points, hypotheticals, and follow-up materials for bringing local communities together.
IV. EXEMPLARY POLICIES AND PRACTICES
Rules and recommendations on discharge planning from federal agencies, and samples of established discharge policies and protocols in Massachusetts.
A. Introduction to Exemplary Policies and Practices B. Exemplary Practices in Discharge Planning: Report and Recommendations of the Working Conference
June 1997 report of Interagency Work Group on Improving Discharge Planning, published by SAMHSA.

C. CMHS Cultural Competence Standards for Discharge Planning in Managed Care Mental Health Services
D. HUD McKinney Act Special Project Certification Form for Discharge Planning

Since 2000, HUD has required state and local government applicants for homeless funds to certify that the community has in place policies and protocols to prevent the discharge of individuals into homelessness, and to report on progress in developing and implementing such protocols.

E. Massachusetts Executive Office for Administration and Finance Policy Report: Moving Beyond Serving the Homeless to Preventing Homelessness

Excerpts from the 2000 report of the Commonwealth of Massachusetts, which convened all relevant state agencies in a discharge planning work group that gave attention to policies and procedures in correctional facilities and human services agencies.

F. Massachusetts Department of Mental Health Discharge Protocol

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	V. IMPROVING OUTCOME
	Concrete approaches to connecting institutions to making connections between institutions and residential systems.
	A. Introduction to Improving Outcomes B. Optional Purchasing Specifications: Medicaid Managed Care for Individuals who are Homeless
	George Washington University Medical Center, School of Public Health and Health Services, Center for Health Services Research and Policy

C. Improving Behavioral Health Services and Discharge Planning for Homeless individuals

Massachusetts Division of Medical Assistance (DMA) and the Massachusetts Behavioral Health Partnership (MBHP)

D. Discharge Planning Specifications for Requests for Responses
E. Triple 8: The Road Home

Summary of an interactive multimedia information tool that provides current vacancy information on next step transitional and permanent resources and can be accessed by FAX or on the Internet by case managers and discharge planners.

F. Medical Respite Services for Homeless People: Practical Models

by Marsha McMurray-Avila, National Health Care for the Homeless Council

G. For people with serious mental illnesses: Finding the Key to Successful Transition from Jail to the Community – An Explanation of Federal Medicaid and Disability Program Rules

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