Health, Homelessness & Addiction

Thank You:

Thank you to the Department of Health Services for their ongoing commitment to collaborate widely to come up with the best plans to address the challenging and complicated issues facing our state.

Background:

Methamphetamine use has ravaged our rural northern communities, much more so than opioids, though the use of prescription drugs and alcohol are additional substances of concern. Regardless, these substances lead to addiction issues severely impacting local and county law enforcement personnel, court systems, jails, county public health and human services departments, as well as families and individuals’ health status, all leading to increased joblessness, devastated families, children who are being displaced and experiencing homelessness. 

The issues:

       Barron County in 2016 had 30+ crime lab cases, with Washburn and Sawyer Counties each had 10-19 crime lab cases, while Rusk County had 20-29 crime lab cases for methamphetamine. In comparison, Dane County had only 1-9 crime lab cases and Sauk County is at zero crime lab cases (Marshfield Clinic Health System, Northwoods Coalition, and the Alliance for Wisconsin Youth, 2018). 

       Barron County ranks 29th out of 72 Wisconsin counties, while Sawyer ranks 69th in regard to the worst health outcomes. In comparison, to Dane County ranks at a health ranking of 7. However, of most concern are the ranking comparisons in the health disparities with Dane County ranking at 9, and the northern counties ranking from 47th (Barron) to 70th (Sawyer) as being the worst. (University of Wisconsin Population Heath Institute, 2017a). This is a broad snap shot indicative of many health inequities, and one of them is housing. There needs to be changes made in strategies to deal with methamphetamine, alcohol, and other substance addictions. 

       It is essential to consider a holistic approach to the overall health issues around mental health and addiction given the extensive devastation occurring in individuals, families, and our communities. There are substantial costs of health care for inpatient residential treatment, outpatient, emergency care treatment, and overall loss of human capital, etc. Health issues around addictions lead to increased traumatized rural communities when we do not approach the root issues, given this typically low skill population already contends with lower wages, lack of availability to participate in the workforce, lack of education/training, absence of social inclusivity and supportive community relationships all of which further leads to increased decimation and a crumbling of families and communities.

 

       Evidence supports the creation of sober living housing which provides individuals a place they can put to use the new sober living skills they learned in inpatient and outpatient treatment. Treatment provides the very basics of sober living. Sober living houses provide the place newly sober individuals learn to implement the skills they learned in treatment away from past destructive relationships and living conditions. If these newly sober individuals go back to their former way of living positive sober outcomes are drastically reduced.

Ø  Polcin D. L., Korcha R., Bond J., Galloway G. (2010). What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here? Journal of Psychoactive Drugs, 42(4), 425-433. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057870/   Lack of a stable, alcohol and drug free living environment can be a serious obstacle to sustained abstinence. Destructive living environments can derail recovery for even highly motivated individuals. Sober living houses (SLHs) are alcohol and drug free living environments for individuals attempting to abstain from alcohol and drugs. They are not licensed or funded by state or local governments and the residents themselves pay for costs. The philosophy of recovery emphasizes 12-step group attendance and peer support. A study was performed of 300 individuals entering two different types of SLHs over an 18 month period. The paper shown in the link above summarizes the published findings documenting resident improvement on measures of alcohol and drug use, employment, arrests, and psychiatric symptoms. Involvement in 12-step groups and characteristics of the social network were strong predictors of outcome, reaffirming the importance of social and environmental factors in recovery. The paper adds to previous reports by providing a discussion of implications for treatment and criminal justice systems. It also describes the next steps in research on SLHs, which will include: 1) an attempt to improve outcomes for residents referred from the criminal justice system and 2) a depiction of how attitudes of stakeholder groups create a community context that can facilitate and hinder the legitimacy of SLHs as a recovery modality

       Evidence has shown that strategies that constitute Housing First Type Initiatives could be better implemented if various Wisconsin State departments could allow collaboration and collective impact to occur. 

       Proposed ideas to address this increasing need in rural northwestern Wisconsin is to consider a Homelessness Prevention and Rapid Re-Housing Program (HPRRP), which has been very successful in addressing homelessness for our Veterans (United States Department of Housing and Urban Development (2018); University of Wisconsin Population Health Institute, 2017b) and with individuals faced with mental illness (Smelson, et al.,2016).

       Housing First Models are successful as they approach stabilization of the individual/family rather than being placed in temporary shelters or in transitional programs, where there is a good likelihood of needing to move frequently. Stigma and a lack of understanding about the disease of addiction has limited funding and cross departmental approaches to be used in the best manner to stabilize housing and provide funding for community supports. These are all essential pieces for someone to be successful on their journey of recovery from an addiction whether it be through a sober living house (Polcin & Henderson, 2008), a transitional program, and/or a more stable “housing first initiative” in the community (Alcoholism & Drug Abuse Weekly, 2008). 

       Collaborative initiatives between community development, non-profit agencies, health and human services, etc. are difficult to implement given the existing barriers within the Wisconsin Departments to facilitate a holistic, case management approach to address issues around housing and other factors to stabilize a family. The removal of barriers to support funding efforts to facilitate new and supportive partnerships helps for the development of programmatic partnerships to work together with the individual/family. Also, landlords are more likely to rent to someone who has an involved case manager, knowing the case manager is there to help if tenants have issues.

       There are a variety of tools and/or programs available that could be included within a Housing First initiative. The University of Wisconsin Population Health’s website lists the following initiatives as ranging from expert opinion to scientifically supported that could be considered and utilized more efficiently in rural communities. These initiatives include: affordable housing tax increment financing (TIF), community development block grants (CDBGs), community land trusts, HOME investment partnership program, housing choice voucher program (Section 8), housing first, housing rehabilitation loan & grant programs, housing trust fund, low income housing tax credits (LIHTCs), service-enriched housing, and mixed-use development (University of Wisconsin Population Health Institute, 2017c). 

 

It is with this information in mind, the Heart of the North requests assistance from Wisconsin Department of Health & Human Services in intradepartmental efforts to use strategies, funding, and other program resources available through Wisconsin Housing Economic Development Authority,  Health, Housing & Addiction Issues, DOA, Department of Children and Families, WEDC, Health and Human Services and others such as USDA, to address the health, housing, and addiction issues ravaging our rural communities. 

We offer to host a meeting of these agencies in Rice Lake to discuss these challenges and create workable solutions.

 

Consideration of possible strategies include:

1.      Interagency activities/events – to engage leadership teams from applicable state departments and federal agencies to identify aligned areas that can collectively impact housing, addition recovery, and economic stability for populations in need.

2.      Coalition building activities – with county level departments such as with county boards, health and human services, law enforcement, district attorney/judicial court systems, public health, economic development and others who may potentially impact individuals/families in recovery.

3.       Provide matching grant funds – available from a state agency to counties who through effective collaborative coalitions engage a wide network of community partners (including local law enforcement, district attorney/judicial court system, public health, human services, economic development, etc.) along with representation of families/individuals in recovery to implement plans to become more inclusive and supportive of becoming a recovery community with available, affordable and stable housing. 

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