One of the key priorities of the outreach team is to connect homeless individuals with benefits, particularly Supplemental Security Income and Social Security Disability.
The Truman Medical Center Behavioral Health (TMCBH) team refer to themselves as the “Benefit Brothers,” although they are not brothers. They laugh when they use the moniker but it signals the highly collaborative working relationship that Jared Reck, Eric Godfroy and Baylee Hardman have forged in working to provide enrollment assistance to homeless individuals with significant behavioral health needs and other conditions.
They are part of Truman’s Assertive Community Outreach (ACO) team focused on identifying and conducting enrollment assistance to homeless or precariously housed individuals across Kansas City through an assertive outreach effort. One of the key priorities of the ACO team is to connect homeless individuals with health coverage and other benefits, particularly Supplemental Security Income and Social Security Disability. Completion of these application processes lays the groundwork for qualifying for Medicaid, housing benefits and other supports that can help this population attain stability within the community.
The REACH Foundation awarded TMCBH a $50,000 grant within the Enroll All Eligible outcome investment area to provide assistance with enrollment in health coverage and other publicly supported benefits. The REACH strategic plan places a priority on helping highly vulnerable populations access coverage and other benefits. The Truman project addresses a particularly vulnerable population group – individuals whose mental health and housing instability places them at high risk for health, safety and other concerns.
Sara Schwab, the ACO team leader and director of Projects for Assistance in Transition from Homelessness (PATH), says this outreach team is unique because “we take what we call an assertive approach – we don’t wait for the clients to come to us. And we don’t give up.”
One of the components of TMCBH’s grant proposal was to add a third position to provide additional enrollment assistance, working both with the outreach team and assisting other clients referred through Truman’s inpatient psychiatric unit. Collectively, through referrals and street outreach, TMCBH and the ACO team recruit more than 400 homeless individuals a year, enrolling approximately 250 in case management and supportive services.
Hardman, who provides that extra assistance, works with clients referred through TMCBH in-patient care and with her teammates to facilitate the necessary Social Security and disability applications and to assess for additional unmet needs. The process is time-consuming – taking multiple hours and interactions with clients to complete, sometimes over a period of weeks if a client disengages or loses contact. The effort goes beyond simply filling out applications; it also involves gathering medical records from multiple providers, coordinating with clinical teams to obtain evidence for the application, accompanying clients to appointments with the Social Security Administration, and keeping clients who may not be trustful of the process or recognize how it will benefit them engaged in the process.
Godfroy, a licensed clinical social worker, says the engagement component of the work is especially crucial. “A lot of our clients have untreated symptoms, but in order to get them into a stable situation, we have to work with them on that eligibility for services – and there are a lot of bureaucratic rules and trust issues to overcome in that process.” He said the process often involves multiple visits, and still “we might lose contact with some for a while – but we go out and find them.”
The enrollment and eligibility process is time-consuming – taking multiple hours and interactions to complete, sometimes over a period of weeks if a client disengages or loses contact.
Clients may be living in shelters, group homes or in homeless camps. Outreach staff keeps track of their canvassing activities and visits to shelters, group homes, service providers and homeless camps. In this way, the ACO team has built a network of relationships with crisis centers, shelters and other locations so that they can be alerted when a client with whom they have been working reappears.
Schwab agrees that client engagement – the ability of the outreach team to build trust – is key to opening the door for services. Reck, Godfroy and Hardman each emphasize how relationship-building can help clients move along a continuum from urgent concerns about their most immediate needs, such as food or that day’s shelter, to participating in homelessness remediation services and receiving medical and behavioral health care, and ultimately to being able to access employment services.
“We run into hurdles, but we keep working the process and our relationships with our clients and other agencies and groups in the community – we don’t let these hurdles keep us from working to move our clients forward,” Godfroy said.