DHS HFH Medical Director: Interim Housing Outreach Program (IHOP)

Housing for Health (HFH) is a program office within Health Services Administration, a division under the Los Angeles County Department of Health Services (DHS). HFH administers a large percentage of the Los Angeles County CEO-Homeless Initiative’s Measure H programs which combat homelessness through housing and services throughout Los Angeles County.

According to the 2023 Greater Los Angeles Point-In-Time Homeless Count conducted by the Los Angeles Homeless Services Authority (LAHSA), there are 75,518 people experiencing homelessness (PEH) in Los Angeles County. Of this number, 55.155 are unsheltered and 20,363 are in interim housing settings, marking Los Angeles County with the unfortunate distinction of having the largest unsheltered homeless population in the nation. Although significant efforts and resources have been allocated to the development of permanent affordable housing solutions, including Permanent Supportive Housing (PSH), there is no question that interim housing continues to play a significant role in addressing the immediate and future needs of unsheltered PEH.

While interim housing sites are funded by a collection of public and private dollars and other partners and available to any person experiencing homelessness, the reality is that PEH often have a variety of complex needs which limit their ability to successfully access and/or maintain residency in these settings despite their desperate need for shelter. For example, interim housing sites are traditionally staffed by homeless service providers who are ill-equipped to serve individuals with more complex medical needs (e.g., colostomy bags, wound care), mental health conditions (e.g., psychotic spectrum disorders) and/or substance use disorders (e.g., methamphetamine or opioid addiction) as well as individuals who need support with activities of daily living (ADLs) such as bathing, eating and dressing and/or independent activities of daily living (IADLs) such as managing medication and finances.

This was highlighted in the 2020 preliminary report conducted by LAHSA entitled Higher Level of Care Needs Among People Experiencing Homelessness at Los Angeles County Project Roomkey Sites which found that a subset of individuals with complex health and/or mental health conditions which significantly impaired their ability to engage in ADLs/IADLs resulting in them being recommended for a higher level of care by site operators and LAHSA site coordinators because the interim providers did not have adequate funding or staff trained to provide the needed supports which put the individuals at risk of returning to homelessness.

Accordingly, as part of the system of care in Los Angeles County, DHS and the Department of Mental Health (DMH), and the Department of Public Health Substance Abuse Prevention and Control program (DPH-SAPC) have been intentional about designing, implementing and partnering in programs that can address the wide range of needs that PEH may experience. This has included providing specialized psychiatric street outreach through DMH’s Homeless Outreach & Mobile Engagement (HOME) teams as well as providing integrated specialized supportive services once someone is in permanent housing through DMH’s Housing Supportive Services Program, DHS’ Intensive Case Management Services (ICMS) Program and DPH Substance Abuse Prevention and Control’s (SAPC) Client Engagement and Navigation Services (CENS) Program.

However, the County currently lacks the dedicated resources needed to be able to respond to requests for field-based, on-demand and proactive health, mental health and substance use services in interim housing settings for individuals living with symptoms and functional impairments associated with severe mental illness, chronic health conditions and/or substance addiction. Given the prevalence of health, mental health and substance use disorders among PEH, it is critical to provide interim housing residents with on-site access to health, mental health and substance use services and supports would fill an important gap in the homeless services system and offer assistance that is imperative to supporting a successful interim housing experience.

IHOP

Using Housing and Homelessness Incentive Program (HHIP) funding from Managed Care Organizations (e.g. LA Care, Health Net, etc.) and MHSA dollars from the state, the three county health agencies are coming together to create regional, field-based, multidisciplinary teams that are specifically dedicated to serving people experiencing homelessness (PEH) who are living in interim housing in an effort to address current gaps in behavioral health and physical health services, support interim housing stability and transition to permanent housing, and prevent a return to homelessness. The teams will serve all eight Service Areas in Los Angeles County and will be comprised of staff from DMH, DPH SAPC and DHS Housing for Health (HFH) to ensure attention to the full spectrum of client needs. These teams will be called the Interim Housing Outreach Program (IHOP) and will be comprised of both medical and behavioral health staff to provide direct services to high-risk clients as well as provide support to interim housing staff as they prioritize and expedite social and housing navigation services for these high-risk clients.

DMH and DPH will sponsor the behavioral health component of this effort including the provision of onsite specialty mental health and SUD care and supports. Behavioral health services will include crisis response, outreach, triage, screening/assessment, medication support, crisis intervention, linkage to longitudinal care and consultation. Substance use educational groups will also be held at the interim housing locations that will offer residents an overview of SUDs and the treatment system as well as a more specific curriculum targeting those at risk of SUDs focused on overdose and relapse prevention, harm reduction and recognizing the health consequences of substance use and connection to mental health.

DHS HFH build out the medical component of this effort. Medical staff (including mid-level providers, nurses, and occupational therapists) will complete a comprehensive assessment of the client within the physical health, life negotiation, and ADL/iADL domains; refer clients for immediate/urgent care as well as establish connections with longitudinal primary and SUD care; assess functional status and arrange for in-home care giver (IHCG) services in the interim housing settings until In-Home Supportive Services (IHSS) can be established in permanent residence; arrange for transfer to HFH-sponsored recuperative care or stabilization housing beds, as appropriate; arrange for transfer to HFH-sponsored enhanced residential care (ERC) beds, as appropriate; work with shelter staff to prioritize social services/community resource navigation for these high risk clients as well as prioritize housing navigation services to support expedited placement in permanent supportive housing (PSH).

Of note: DHS launched IHOP in November 2023 and has been providing assessment and linkage services to clients in SPA 4 (downtown LA). DMH and SAPC will join DHS in the late summer of 2024 with gradual expansion of service scope and location across the county.

HFH IHOP MEDICAL DIRECTOR DUTY STATEMENT

The DHS HFH IHOP Medical Director is responsible for creating, implementing, overseeing, and evaluating the medical service component of the IHOP team directives. The IHOP Medical Director will work closely with their counterparts in the Departments of Mental Health and Public Health to ensure that the affected clients receive a well-integrated, multidisciplinary assessment and immediate-term stabilization plan.

70% of the IHOP Medical Director time will be spent delivering complex care management and stabilizing medical services to clients (in coordination with other IHOP team members) and 30% time will be spent on program management and continuous quality improvement activities.

Duties include:

• Oversee the creation of all IHOP medical service policies/procedures as well as their implementation, effective execution, and evaluation; conduct this work in coordination with program directors at the Department of Mental Health and the Department of Public Health to assure a multidisciplinary/cross-agency effort to address clients’ needs holistically.

• Work closely with HFH programs, including the interim housing, enriched residential care, and permanent supportive housing programs, to provide timely access of eligible IHOP clients to housing opportunities.

• Work closely with the Medicaid managed care plans through regular communication of IHOP successes and challenges. Improve workflows to secure necessary Medicaid benefits for IHOP recipients, including the timely assigned of high-quality CAL AIM funded housing navigators, enhanced care managers (ECM), and in home care givers to eligible IHOP clients.

• Facilitate internal and external meetings to improve program execution, strengthen collaborations, and ensure sustainability of IHOP efforts.

• Be a thought partner in creating, implementing, improving, and evaluating IHOP operations within the medical service branch as well as within the behavioral services and housing navigation branches.

• Lead continual quality improvement (CQI)activities: use data to ensure that desired process and outcomes metrics are being met. Participate in creation and implementation of data collection and analysis processes to ensure data driven CQI activities.

• Develop protocols, policies, and procedures for the IHOP medical team.

• Assist in creation of a cross-agency care management platform to facilitate care coordination of mutual clients across IHOP service partners.

• Hire and manage IHOP medical team members in collaboration with other HFH and DHS hiring managers, including interviewing, onboarding, training, and performance management.

• Train IHOP medical team members in these protocols: ensure that clinical staff have the proper training and tools to manage day-to-day operations successfully and safely.

• Provide clinical supervision to clinical staff performing IHOP activities in the field.

• Assist in procuring resources, both supplies and personnel, to manage IHOP operations effectively and safely in the field.

• Conduct site visits with the IHOP to support operations and perform quality assurance activities.

• Oversee training and technical assistance activities for shelter operators and other community based partners (housing navigators, ECMs, IHCG) in delivery of high-value care to IHOP clients.

• Support the interim housing sites in identifying, referring, and supporting clients through the assessment process as well as in executing the action plan to procure necessary resources and referrals for the clients (e.g. IHCG placement, reasonable accommodations/assistive device procurement and use, accompaniment to medical and social service appointments):
– Develop tool kits and training/technical assistance materials for IH facility staff.
-Work with Interim Housing (IH) facilities to ensure that they have adequate staff and supplies to support the IHOP initiatives.
-Assist IH staff to through with appropriate IHOP-related actions for their clients.
-Manage communication with IH directors and staff.

• Ensure that IHOP reports are created and communicated in a timely manner to internal and external stakeholders.

• Is available on call to ensure adequate response to emergencies at shelters or with the Department of Public Health/Department of Mental Health or health plans.

Scheduling: Generally, Monday through Friday from 8:00 a.m. to 4:00 p.m., though it is not uncommon for individuals in this position to address issues after-hours or on weekends.

Duration of Deployment: At present, HHIP dollars will allow for five years full-time employment.

Qualities/Qualifications: Ideal candidates are physicians with strong organization and management skills. They should have excellent writing skills, be quality-minded, diligent, creative, and empathic given the populations served within the medical shelters.

JOB QUALIFICATIONS

Two years of experience as a medical director or high- level program lead. Experience overseeing the work of a multi-disciplinary team in assessing and providing services to people experiencing homelessness. Experience working with county and community partners in creating and implementing innovative programs.

• Experience working on projects where problem, opportunity, and solution may be unclear.
• Excellent written and verbal communication skills, including the ability to express technical concepts clearly to both technical and non-technical audiences.
• Strong project management and relationship building skills.
• Ability to learn quickly and adapt to shifting priorities.
• Comfort working with data systems and learning new data systems.
• Skill in conducting interviews and facilitating group meetings.
• Strong listening, negotiation, and conflict resolution skills.
• Knowledge of public health and human services programs that are designed to serve the underserved.

Please contact Dr. Heidi Behforouz: hbehforouz@dhs.lacounty.gov if you are interested. Please send a cover letter and resume. Thank you!