Application of a multi-disciplinary team approach to supportive housing case management for high-risk people living with HIV/AIDS (PLWHA)

In 2009, Harlem United received a grant from the New York City Human Resources Administration (HRA), the local Department of Social Services, to provide permanent supportive housing to PLWHA with histories of chronic homelessness and mental illness/substance use, as part of New York State and New York City's landmark NYNY III Agreement to create 9,000 new units of supportive housing in New York City. With this grant, an innovative approach to supportive housing case management was proposed based in part on the Assertive Community Treatment (ACT) model. ACT aims to replicate in the community the intensive multi-disciplinary service patients receive in psychiatric institutions, to help stabilize high risk patients and minimize visits to the emergency room and hospital. Harlem United selected this model after an in-depth needs assessment which resulted in a more tailored approach to addressing substance use and mental illness for the HIV population. The belief was that NYNY III clients would benefit from this more intensive approach to case management, as opposed to the more traditional model whereby one case manager is assigned to a caseload of clients. Over the past three years, we experimented with various adaptations to the model based on our available resources and desire to maintain fidelity to the multi-disciplinary team approach. Our presentation will highlight the successes and challenges with implementing a multi-disciplinary team approach to supportive housing case management based on a cost-benefit analysis of the intervention and data on health outcomes and housing stability from the past three years.