1. Working with Homeless
Youth Living with HIV:
The Youth Housing Initiative @
JRI Health
Jorgette Theophilis
January, 2015

2. Brief History
• Funded by HUD and designated a Special
Project of National Significance
• Began recruiting eligible youth in 2012
• Over the course of the three-year program,
22 youth obtained their own units
– Vast majority kept their housing throughout this
period

3. Key Characteristics of Clients at Entry:
• Educational attainment:
– 74% of original group possessed at least a high school diploma or GED
– Of these, 27% with some college and 9% with either Associate’s or
Bachelor’s
• Minority reported addiction to substances:
– 2- crystal meth
– 1- cocaine
– 1-heroin
– 1- alcohol
• 30% had involvement with the foster care system:
• Clients fell into two main categories at entry:
– In crisis:
– Functioning

4. Key Characteristics, continued
• All but one engaged in medical care at entry
• Low rates of medication adherence while
homeless
• High level of food insecurity
• Two trained as peer health educators prior to
contracting HIV
• Mode of infection:
– MSM: 73%
– Perinatal: 18%
– Other: 9%
• Almost all reported regular marijuana use

5. Client Assets at Entry
• Many had artistic outlets
• Demonstrated self-awareness and honesty
• Three attended AA and/or NA
• Most had established close relationships with
medical teams

6. Service Delivery Systems
•Seven major systems:
– Benefits (SNAP, EA, SSI, TAFDC)
– Housing
– Medical Care
– Mental Health
• Inpatient
• Outpatient
– Substance Abuse treatment
• Inpatient
• Outpatient
– Job training/linkage & education
– Criminal Justice

7. Program Stages:
• Engagement
• Housing Search
• Stabilization

8. Engagement:
• Built rapport with clients
• Conducted comprehensive assessment to identify
service needs
• Crisis management
• Assisted with public benefit applications
• Completed MBHP application for housing voucher
• Made referrals as necessary

9. Housing Search
• Assisted with housing search
• Taught youth to interact effectively with
landlords and property managers
• Attended lease signing with client
• Assisted in completing furniture and
security deposit applications

10. Stabilization
• Use motivational interviewing tools to elicit client’s main
motivators
• Complete Career Interest Inventory
• Explore opportunities for permanent housing
• Create or revise a resume
• Meet with JRI Peer Support team as needed
• Update Needs Assessment, review goals, and client
action plan
• Introduce Financial Literacy Tools
• Meet regularly with case manager to develop a plan for
self-sufficiency
• Ensure all clients are linked to mainstream benefits

11. Our Approach
• Created a multi-disciplinary team
• Took a holistic approach in client work, learning as
doing, adapting as needed
• Focused on permanent housing early on
• Focused on employment and education
• Relied on texting as primary mode of communication
• Incorporated a developmental approach; Developed new
partnerships with range of organizations, including
community college
• Worked much more closely with housing partner during
leasing up period

12. Challenges
• Emerging mental illness compounded by
substance abuse—
– inadequate crisis response system for youth;
– lack of psychiatrists and psychologists with
expertise in treating adolescence;
– Separate systems for inpatient/outpatient
mental health & substance abuse treatment
– No coordination or sharing of client
information with medical/outpatient mental
health services

13. Challenges
• Treating the symptoms vs. the cause?
• Insufficient time in detox and psych units
Resistance to therapy

14. Key Program Accomplishments:
– 22 youth obtained housing voucher
– 6 graduated to permanent housing
– Viral load suppression prevalence increased from 50% at
baseline to 75% at end of program
– One client completed his Associate’s and another entered
college during this program
– Created new partnerships with local community college and
local emergency youth shelter
– Strengthened and broadened already-existing partnerships

15. Case Study 1: Background
• Living on streets at time of entry
• Struggling with polydrug abuse
• Emerging mental illness & PTSD
• Newly-diagnosed
• Escorting

16. Case study of Client in Crisis at Entry
Intake:
Referred by
Peer Support
program at JRI
• In medical care,
but not
consistently
Housing:
• Applied for
subsidy
• Conducted
housing search
Detox for 30-
days:
In a dual
diagnosis unit

17. Case study of Client in Crisis at Entry
Post-detox:
• Released to
community-based
program for 30 days
• Resumed using
• Prescribed anti-
psychotics; anti-
depressants and
mood stabilizer
Resumed
Housing Search:
• Conducted housing
search
• Found apartment
• Moved in
Accessed
community
resources:
Rental startup
Furniture bank
As housing stabilized, engagement in medical care increased to high level

18. Case study of Client in Crisis at Entry
Crisis intervention:
• Came to office with
suicidal ideation
• Intervention by local
crisis team
• Brief stay in MGH
psych unit
• No coordination of
services between
crisis team; hospital;
PCP. and community
resources
Crisis involving police:
• Taken by police to
McLean’s for two-week
inpatient stay
• Evaluated by team who
could identify symptoms
but not diagnosis
because of drug use
• No follow up on site for
post-release services
• Released again to CB
services
Post-release:
Joined AA
Connected with CB-
services
Prescribed psych meds by
PCP
Refuses therapy or peer
support

19. Case study of Client in Crisis at Entry
Arrested &
imprisoned:
• While in jail,
detoxed &
• Took psych meds
and stabilized
On parole:
Obtained a
series of jobs;
held them for
few weeks-
months
• Applied to MA
Rehabilitation
Commission
• Opted for sponsor at
AA, measure of
increased commitment
to program

20. If we had to do it all over again…..
• Develop a congregate model
• Use housing as a leverage for
engagement in education and/or
employment
• Incorporate group activities
• Include mindfulness programming

21. Continued…...
• Develop and offer on-site multidisciplinary
mental health available on a drop-in basis
• Hire a part-time education/job
development coach