an integrated program for homeless adults with co

Brandon Evans
Presented to the School of Social Work
California State University, Long Beach
May 2013
The prevalence of co-occurring mental and substance use disorders is high, in
fact, co-occurring mental and substance use disorders affect approximately five
million adults in the United States (Jessup & Dible, 2011).
Individuals who experience co-occurring mental and substance use disorders
stand a greater risk for chronic homelessness, poor health, high suicide rates,
HIV/AIDS, and frequent interactions with the criminal justice system when
treatment is prolonged (Buckley, 2007; Horsfall, Cleary, Hunt & Walter, 2009).
In 2011, data from the Greater Los Angeles Homeless Count Report revealed
that there are approximately 51,340 homeless adults living in the County of
Los Angeles, among these numbers an estimated 16,942 adults are
experiencing a mental illness, and 17,455 are experiencing a form of substance
abuse (LAHSA, 2011)..
The overarching goal of the program is to decrease the prevalence of cooccurring disorders among the homeless and offer effective treatment for
mental illness and substance use disorders.
Three commonly used integrated interventions for co-occurring disorders are,
screening and assessment for mental illness and substance use disorders,
motivational and behavioral interventions, and incorporating a common
treatment plan which addresses both illnesses (Foster, Lefauve, Kresky-Wolff,
& Rickards, L. 2010).
The social work profession has had a history of helping vulnerable and
oppressed client populations (Sun, 2012). Homeless individuals
experiencing co-occurring mental and substance use disorders are
considered one of the most vulnerable client populations to work with
(Sun, 2012).
Social workers are often the first professionals in contact with adults who
are homeless and experiencing a co-occurring mental and substance use
disorder and thus become ideal candidates to build rapport and begin the
assessment process to deliver effective treatment (Drake et al., 2001).
Three commonly used social work interventions for co-occurring disorders
are, screening and assessment for mental illness and substance use
disorders, motivational and behavioral interventions, and incorporating a
common treatment plan which addresses both illnesses (Foster et al.,
A recent survey among 642,000 positions held by social workers found
that 21 % worked in substance abuse and mental-health related fields
(Sun, 2012). Among these health related fields, social workers are often
first to come in contact with multicultural and multiracial clients
displaying substance abuse and mental illness (Hall, 2001; Sun, 2012).
As the diverse population continues to grow, so will cultural diversity
among consumers, adding to the challenges social workers face with
clients who are multicultural and/or multiracial experiencing a cooccurring disorder (Hall, 2001). It is crucial that social workers be
culturally competent with assessment and treatment delivery, all while
using theories and interventions that are grounded in multicultural
diversity (Hall, 2001; Sun, 2012).
Target Population
The target population for this grant is homeless adults who have a cooccurring mental and substance use disorders and who will be receiving
services in Los Angeles County, more specifically, San Pedro, California.
Strategies Used in Selecting a Funding Source
The grant writer used multiple methods to search for a potential grant
that would fund and match the program’s purpose, population, and target
area, this included consulting the resource library on the California State
University Long Beach (CSULB) campus and the Long Beach Nonprofit
Partnership library to locate potential private, public, government,
county, and/or state grant funding sources.
Funding Source
Upon review of all potential funding sources, The McMillen Family
Foundation was selected as a funding source for this grant because the
criteria of the grant guidelines were consistent with the nature of the
program’s purpose and population which it will be serving.
Sources Used for the Needs Assessment
Several sources were used to allow the grant writer a more accurate
account of the problem, this included a scholarly search of the literature,
Los Angeles Homeless Services Authority (2011), National Coalition for
the Homeless (2009), National Alliance on Mental Illness (2003), and the
Substance Abuse and Mental Health Services Administration,(2010).
Program Budget
The approximate budget and funding request for this proposed integrated
program and evaluation plan is $192,742 for one year. The funding will
include salaries for a consulting psychiatrist, a masters level social
workers (MSW), a clinical licensed social worker (LCSW), operational
costs, direct and indirect program costs, and administration. Other
expenses include; utilities, gift cards, expenditures linked with active
referrals associated with the program.
Program Summary and Description
Upon admission, the program will screen for co-occurring disorders using an
integrated assessment, provide assistance in mental health recovery and
addiction treatment while providing a safe place for homeless adults with a cooccurring disorder to go to attend individual therapy, psychoeducational
groups, and co-occurring self-help groups.
Population Served
The proposed program will target the growing number of co-occurring mental
health and substance abuse (MHSA) disorders among homeless adults living in
Los Angeles County, California. The program will run in conjunction with the
Beacon House Association of San Pedro.
Programs Objectives
The program objectives are to, (1)decrease the prevalence of untreated and
undiagnosed co-occurring disorders by enrolling new clients into the program
each month and providing each with an individual service plan, treatment
goals, and a medication plan to work toward recovery, (2) increase client’s level
of adherence to psychotropic medications and symptom management through
the program’s weekly psychoeducational groups, and (3) decrease the number
of homeless clients with a co-occurring disorder by providing emergency
housing vouchers. A minimum of 60 emergency housing vouchers will be
provided within the first year of the programs operations.
Program Evaluation Plan
For the purpose of evaluating the program's effectiveness in promoting
recovery, the Milestone of Recovery Scale (MORS) will be implemented
my each staff member to measure their client’s observable behaviors
related to their recovery. The Milestone of Recovery Scale (MORS) is
based on a rating scale from 1 to 8, with “1” being an extreme risk, and “8”
being advanced recovery.
In order to evaluate the programs anticipated goal of serving 180
unduplicated clients’ and providing 120 active referrals in 1year, the
program will implement a documentation system on all client records.
The information will be entered into an online spread sheet created by the
social worker. The program director and the social worker will calculate
the numbers each quarter, and then do a final evaluation on the 12th
month to insure the program is within its projected goal of serving 180
clients diagnosed with a co-occurring disorder, and providing 120 active
referrals to other agencies. This information will be analyzed and
interpreted by the clinical team for future program development.
In the nonprofit world it becomes apparent that grant writing can play an
important role in the funding requirements to develop programs to serve
clients who need services. Social workers become important players in
this process because they are culturally aware and culturally sensitive to
the needs of all human lives.
The Code of Ethics of the National Association of Social Workers (NASW)
reminds us that part of the social worker’s job is to enhance human lives
and help meet the basic needs of all individuals (NASW, 2013). This
includes the vulnerable, underserved, oppressed, and the ones living in
poverty (NASW, 2013).
Homeless adults experiencing co-occurring mental and substance use
disorders are considered a client population who is vulnerable,
underserved, and often living in poverty (Sun, 2012).
Buckley, P. (2007). Dual diagnosis of substance abuse and severe mental illness: The
scope of the problem. Journal of Dual Diagnosis, 3(23), 159-162.
Drake, R., Essock, S., Shaner, A., Carey, K., Minkoff, K., Kola, L. . . . & Rickards, L.
(2001). Implementing dual diagnosis services for clients with severe mental
illness. Psychiatric Services, 52(4), 469-476.
Foster, S., Lefauve, C., Kresky-Wolff, M., & Rickards, L. (2010). Services and supports
for individuals with co-occurring disorders and long-term homelessness. Journal
of Behavioral Health Services and Research, 37 (2), 239-251
Hall, R. (2001). Biracial sensitive practice: Expanding social services to an invisible
population. Journal of Social Services and Social Welfare, 28(2), 23-36.
Horsfall, J., Cleary, M., Hunt, E., & Walter, G. (2009). Psychosocial treatment for
people with co-occurring severe mental illness and substance use disorders: A
review of empirical evidence. Harvard Review of Psychiatry, 17(1), 24-34.
Jessup, M., & Dibble, S. (2011). Validity and reliability of the COJAC screening tools
for co-occurring disorders. American Journal on Addictions, 20(3), 264-270.
Los Angeles Homeless Services Authority. (2011). Greater Los Angeles homeless count
report. Retrieved from:
National Association of Social Workers. (2013). Code of Ethics. Retrieved from
National Alliance on Mental Illness. (2003). Dual diagnosis and integrated treatment of
mental illness and substance abuse disorder. Retrieved from
Sun, A. (2012). Helping homeless individuals with co-occurring disorders: The four
components. Social Work, 57(1), 23-37.

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