The Outreach and Representative Payee program (OPP) works to to identify, assess, and ensure the safety of homeless persons who have disabilities, and to link them with services that help them achieve permanent housing, recovery, and independence. OPP is a Supportive Housing Program funded through the U.S. Department of Housing and Urban Development (HUD). It is one of approximately 40 programs that comprise the Cuyahoga County Continuum of Care created by the Cleveland and Cuyahoga County Office of Homeless Services (OHS).

OPP serves homeless people who have any disabling condition, including a physical disability, or a disability resulting from alcohol and drug addictions. Because of this, OPP serves a broader scope of homeless persons than the MHS PATH program that serves only homeless people who have a severe mental disability.

Both programs bring services promoting health, housing, and independence to homeless people who are not in shelters. MHS PATH outreach begins at 6:00 a.m., before homeless shelters close, while OPP outreach begins in mid-afternoon and ends at 10 p.m., after the time that most homeless shelters stop taking non-emergent admissions.

Most OPP clients have a physical (87%) disability, and 38% are also alcohol- or drug-dependent. Outreach efforts are designed to serve the highly-vulnerable, and those who do not follow up after an initial service. Many are unable to fulfill the complex procedures and rules required to obtain or maintain income and healthcare benefits. Many would also feel overwhelmed if asked to follow a complex medical regime. Most OPP clients are estranged from family and friends; many have had negative experiences with service providers; and many have been victims of violence.

OPP clients who most readily participate in services are those with a severe physical disease (e.g., kidney failure, Huntington’s or Parkinson’s disease, severe diabetes, cancer, heart and pulmonary diseases, and HIV/AIDS). They have become unable to take care of their needs, and have experienced feelings of hopelessness and despair. Many became homeless after losing a job because of their illness, and some are unaware that they are eligible for services and benefits. OPP helps them to complete and submit applications for income, healthcare, and housing benefits, and to participate in administrative interviews and hearings needed to obtain these benefits. OPP provides services until they are stable, housed and able to succeed on their own.

Those who are more reluctant to participate in services often have a disabling mental or developmental disorder, including a growing number of older men and women with dementia. Successful engagement may take months, or even years, because of their impaired judgment. They are withdrawn, often avoiding shelters and meal sites, and found in abandoned buildings, or sleeping on sidewalks and park benches. Their efforts to obtain or maintain housing is often thwarted by severe cognitive disorganization. OPP staff members work to engage these clients by frequent visits, offers of coffee, snacks, and hygiene items, and offers of support. The engagement process is different for each person depending on his or her disability and degree of paranoia.

Those having a severe mental illness eventually respond to patient and persistent outreach efforts. These clients typically lost housing due to an inability to care for their basic needs, an unwillingness to take medicine and keep appointments with healthcare providers, poor money management, and poor daily living skills. At times, persons with impaired judgement will walk or wander away from group homes or nursing homes without a place to go, no ID’s, and no plan for housing or services. Housing, at least initially, must be able to provide for all of their needs, or access those needs not provided. Safe Havens or transitional housing programs with supportive services are the best choices initially for those with a severe mental illness and/or MRDD. These facilities help them learn the needed skills to move to a less restrictive setting. These skills include: money management, ADL and community living skills, an understanding of their medical and psychiatric needs including medication, linkage with job training and social support networks. Later, they can be transitioned to a group home, a subsidized apartment, section 8, SRO, or home to family/ friends. They will always need community supportive services. Those that are unable to care for themselves even with supportive services, are placed in a nursing home.

The last cluster of homeless men and women with disabilities comprise those who have grown accustomed to a homeless way of life and are reluctant to make any changes. They have developed a social network that provides them with a sense of family. Mealtime is shared. They watch each other’s belongings in the shelters. These homeless individuals are most often those with a chemical dependency problem, borderline intellectual functioning, a personality disorder associated with chemical dependency, and those with HIV/AIDS. These clients tolerate homelessness and poverty until they experience a crisis, either medical or psychiatric, or become arrested. For those with chemical dependency issues, linkages are made to treatment programs and the treatment provider handles all the supportive services, including placement into housing. Those persons with borderline intellectual functioning are linked with a group home, a subsidized apartment, section 8, SRO, boarding homes, or reunite them with family/friends. Usually, referrals are made to CMHA and HUD buildings that provide supportive services on site. Referrals are also made to vocational/job training programs. OPP staff members provide follow-up services until they are stable, housed and able to succeed on their own.

The achievement of residential stability is particularly challenging for homeless people who have disabilities, since it requires that they acquire (or relearn) skills in many domains: personal hygiene; safety; household management; food selection, preparation, and storage; money management; socialization; recreation; and health maintenance. Clients need considerable assistance to complete applications for income and healthcare insurance benefits, and to negotiate the complex procedures required after the application has been submitted. Clients need consistent support and encouragement to overcome their social withdrawal and distrust of others, and to maintain their motivation. Supportive services are also needed to help clients recognize and understand the unique experiences and features of their mental disorder. Clients are not required to be taking medications upon entry into the program., but are helped to follow the recovery plan they create with their social worker and psychiatrist.

To learn about other MHS programs providing coordinated care
for homeless persons with disabilities, click on the links below.

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Mental Health Services for Homeless Persons, Inc. (MHS)
1744 Payne Avenue; Cleveland, Ohio 44114 U.S.A.
216-623-6555 - TTY/TDD: 216-623-6540

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http://www.mhs-inc.org/Outreach2.asp
It was most recently updated on 7 July 2008.
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