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U.S. Department of Health and Human Services

Telehealth Webinar for CBOs Series Part 3- Alternative Description for Time-Based Media

Addressing Barriers for Homelessness and Connectivity

The following is a text alternative description for Telehealth Webinar for Community Based Organizations Series - Part 3: Addressing Barriers for Homelessness and Connectivity.

[The video is a recording of the Telehealth Webinar for Community Based Organizations Series - Part 3: Addressing Barriers for Homelessness and Connectivity. It features the slides and audio from the operator and presenters from the webinar.]


[Presenter - Operator:]

Welcome and thank you for joining today's webinar on Telehealth for Community-Based Organizations: Addressing Barriers for Homelessness and Connectivity. Before we begin, please ensure you've opened a WebEx chat panel by using the associated icon located the bottom of your screen. If you require technical assistance, please send a chat message to the event producer. To submit a written question, you may either select all panelists from the drop-down menu in the chat panel, enter your message in the message box provided, and press enter on your keyboard. Alternatively, there is a Q-and-A box at the bottom right of your screen that you are welcome to post Q-and-A questions that the audience can also see. All audio connections will remain muted for the duration of this webinar. There will be no verbal Q-and-A conducted today. With that I'll turn the call over to Cheryl Levine. Cheryl, please go ahead.

[Presenter - Cheryl Levine:]

Hello, good afternoon. Thanks for joining our webinar on telehealth for community-based organizations addressing barriers for connectivity for every individual who is experiencing homelessness and connectivity. If we can go to the next page. My name is Cheryl Levine. I'm with ASPR, the Office of the Assistant Secretary for Preparedness and Response with H-H-S where I serve as the Director of our At-Risk Individuals program and my partners for providing this webinar for you today include Liz Palena Hall who’s been on detail with us. Thank you to her office: Office of the National Coordinator for Health Information Technology with H-H-S for having Liz spend some time supporting the response as well as our great partners at HUD, and I'd like to briefly introduce – one of our partners in setting up webinar is Christopher Taylor, the acting Deputy Director for HUD Office of Field Policy Management. Christopher if you can say a few opening words, thanks.

[Presenter - Christopher Taylor:]

Thank you, Mrs. Levine and to all of our partners and presenters from the Department of Health and Human Services, the Federal Communications Commission, Universal Service Administrative Company, and Colorado Coalition for the Homeless. Today’s webinars is cohosted by HUD and H-H-S. This webinar is the last installment in the three-part webinar series on telehealth for community-based organizations. I truly want to thank our H-H-S partners for helping to organize these fantastic webinars and bringing the major speakers from the federal government and community-based organizations to share their wealth of expertise and resources with you. As Mrs. Levine said, I'm Christopher Taylor with the HUD Office of Field Policy Management which oversees the Department’s Place-Based Initiative, including the Envision Center demonstration. I personally want to thank all of you for your continued service and hard work to help communities and partners during an ongoing pandemic and economic and social challenges. We really appreciate all our presenters for being able to talk with you all today about the ways to help connect your clients and communities with telemedicine and telehealth services during the Covid-19 pandemic.

Since we have such a great turnout, I do want to take a brief moment to explain what the Envision Center demonstration is to those who are unfamiliar with the concept. In late 2018, Secretary Carson launched the demonstration to centralize resources in a single brick and mortar location. These locations will be called Envision Centers. At HUD we initially identified 18 organizations who demonstrated this concept and we've since grown to 60 organizations, as of yesterday, that have been designated and the number continues to grow. As a designated Envision Center site, HUD commits to these organizations that we will enhance their service to community under four pillars of self-sufficiency: economic empowerment, education advancement, health and wellness, and character and leadership. Today's webinar falls squarely under the health and wellness pillar and we're hoping the knowledge shared by the presenters will help enhance how the Envision Centers serve their communities. If you want to learn more about the demonstration, please visit www.hud.gov/envisioncenters. This webinar is a part of HUD's effort to connect our community partners in our Place-Based Initiative including our envision centers to critical telehealth and telemedicine resources. In case your colleagues were not able to attend today's webinar, the recording and slides will be made available on H-H-S’s website. We’ll also send out materials to all registrants. Without further ado, I’ll pass back the mic to Cheryl to introduce today’s presenters and begin this webinar. Cheryl, please take it away.

[Presenter - Cheryl Levine:]

Thank you Chris. Thank you to my HUD colleagues, and you can go to the next slide, please. As we kick off this webinar today thinking about telehealth and addressing the needs of individuals experiencing homelessness and other issues related to connectivity, I wanted to share with you a resource that I think might be valuable, particularly to folks interested in this webinar, is that – we call this our toolkit for addressing individuals experiencing homelessness and disasters, and this was a project done in partnership with H-H-S, with HUD, and with the Veteran’s Administration and the link is there if you'd like to find this great toolkit that’s available on my website as well as through to the V-A, and if we go to the next page. So it's really a three-part webinar – a three-part toolkit. I just wanted to make sure I highlight what it is for you. There's a section on creating inclusive emergency management systems. Next slide. A section on guidance for those community-based organizations that work with individuals experiencing homelessness on preparing for disasters, and then the next slide, and then the section that we created through H-H-S focuses on health care providers and planning for emergencies for addressing the needs of individuals experiencing homelessness. This is a – I think a really important tool kit. I wanted to raise your awareness of this resource. Okay and the next slide, please.

As Chris mentioned all of these webinars and our three-part series are recorded. We are posting the recorded webinar, the transcript and the questions and answers on our web page. The first webinar is available here. We focus on Services payment and partners back in July. Next page. And then our second webinar was on promising practices. We talked about accessibility and language access on August 26, and so that information likewise is available on our webpage. Next slide, please. Okay, and just some of the housekeeping for this webinar, as we said, it will be recorded and posted later. Please go ahead and provide your questions to the speakers in the Q-and-A box, we’ll collect all those and address the questions at the end of the webinar, and I'm going to hand it over to Liz Palena Hall. She's going to introduce our speakers for this session on connectivity and addressing the needs of individuals experiencing homelessness. Liz.

[Presenter - Liz Palena Hall:]

Thank you so much Cheryl, and next slide, please. And it's my pleasure to introduce our agenda today. First, we'll be hearing from the Federal Communications Commission, the F-C-C, who will provide an overview of their Universal Service Fund programs, including the Lifeline Program. We’ll hear about the application progress and as well as their support for COVID-19 relief efforts and some additional resources. That will be followed by a Federally Qualified Health Center, the Colorado Commission for the Homeless who will discuss promising practices for telehealth and access to care for the homeless, as well as lessons learned during the COVID-19 pandemic. And of course as mentioned that will be followed by a Q-and-A. Please put your comments in the chat. and next slide, please. And without further ado, I'll introduce our speakers, so first up from the F-C-C and from USAC you’ll hear from Micah Caldwell, Special Counsel of Telecommunications Access Policy Division, Wireline Competition Bureau at F-C-C. Stephen Butler, Senior Director of the Lifeline Program at USAC. Leah Sorini, Communication Specialist of the Lifeline Program at USAC. That will be followed by our Federally Qualified Health Center that is also a Health Care for the Homeless Center. We will hear from Andy Grimm, who is the Vice President of Integrated Health Services with the Colorado Coalition for the Homeless and Kaylanne Chandler, who is the Director of Nursing there. Next slide, please. Now I’ll turn it over now to Micah.

     [Presenter - Micah Caldwell:]

Thanks Liz. Hi, everybody this is Micah Caldwell from the F-C-C. If you can go ahead and advance to the next slide and the one after that. Okay. Today, we're going to start out with an overview of the Universal Service Fund, the Universal Service Administrator Company, and then I'll give you some background information on the Lifeline Program. And then I'm going to transition the presentation over to my colleagues at USAC – that’s the Universal Service Administrative Company. They actually administer the Lifeline Program and other Universal Service Fund programs for the F-C-C. While we are the ones who oversee the policies related to the program and the rules related to the program based on our statutory authority, it's actually USAC that does the day-to-day management and operation of the program. I wanted to start out by giving you all just a quick overview of the four different Universal Service Programs that the F-C-C overseas.

We're going to talk mostly today about the Lifeline Program, which is the program I'm involved with. But there are also four other, sorry three other programs, that the F-C-C oversees. The High Cost Program, which you may have heard of as the Connect America Fund. That program is the one where we give funding to service providers to serve and build out infrastructure in rural areas or high cost areas where it's really expensive to deploy infrastructure. We also have the Rural Health Care Program. That's the one that's focused on – and you may already be familiar with this – that’s the one that’s focused on health care facilities and making sure that they have resources and funding to provide telehealth services. And then finally there's the Schools and Libraries Program. As the name suggests that one provides funding to schools and libraries. We also call it the E-Rate Program. So that they can provide communication services and broadband services for students to access, such as Wi-Fi. If you can proceed to the next slide, please.

To focus mostly on the Lifeline Program for purposes of today's presentation, I wanted to give you a quick overview of what it is. What the Lifeline Program is and how we help consumers. Unlike the other three programs which target funding to organizations and entities that provide broadband services, this program is actually designed to help individual consumers. And the way that we do that is we provide a discount each month for consumers that they can receive off of their telephone service bill or their broadband service bill from their service provider. The discount, the standard discount, is $9.25 per month. The way that actually works in practice though is that many service providers that offer a low-income offering will price their offering such that it either is around $9.25 or maybe slightly more than $9.25 so that the Lifeline products that the consumer can sign up for is very low-cost or even free in certain circumstances. One exception to the $9.25 discount is our enhanced support amounts that we will provide. That's available – so it's on top of the $9.25 and that's available to consumers who live on qualifying tribal lands. In addition to the $9.25 per months, they get up to an additional $25.00 so that their total discount is $34.25 a month. To give you a sense of the scope of how many consumers have the enhanced support or get the enhanced support out of the 7 million households that participate in Lifeline about 274,000 of those received enhance support.

One other thing that I want to just touch on really quickly is some of the rules related to the program. A household is defined as a group of people that share income and expenses, and you can only get one Lifeline benefit for household. So if you happen to get questions about how that works for consumers who are in transitional housing situations or experiencing homelessness, so I wanted to make sure that we covered that. If you do not share income and expenses with other people at the location where you reside, multiple people there in their separate households so to speak can sign up for the benefit. So if you are in a homeless shelter, for instance, you don't share income and expenses with most of the other people who live in a homeless shelter, unless maybe it's your family that’s with you. That means that you as your household within the homeless shelter could sign up for the Lifeline discount even if there are other people who lived that location or staying at that location who also receive Lifeline. Could you go to the next slide, please?

In order to qualify for the Lifeline Program, you can do that in a couple of different ways. One is you can show that your income is at or below a hundred and thirty-five percent of the federal poverty guidelines or, which I think is the most common way to do it, is to show participation through a qualifying government program. The major main programs that most consumers are able to qualify through include SNAP, Medicaid, Supplemental Security Income, Federal Public Housing Assistance, and then the Veteran’s Pension or Survivor’s Pension. Now there are also some additional programs that consumers living on tribal lands can use to qualify for Lifeline. And those are the BIA general assistance program, Tribally Administered TANF, Tribal Head Start, and Food Distribution Program on Indian Reservations.

I did want to point out really quickly before I transitioned the presentation over to Leah, and she’ll explain this. The application process is through what we call our Lifeline National Verifier. That is our application system that we use that’s available nationwide, online, and then also we have a paper-based application that Leah will explain. If you are qualifying through one of the programs listed here, we might have a connection to a database that will tell us automatically if you are participating in that program, which is extremely beneficial because that means that you don't have to submit documentation to show your eligibility. We can we can determine your eligibility based on the information through our automated connection. And currently roughly about two-thirds of consumers here apply for Lifeline are able to qualify automatically. Next slide please.

With that I'm going to turn it over to Leah to describe the application process and some of our COVID-19 relief efforts as well as point out some resources that are available to all of you and also point out anything that I might have failed to mention during my portion of the presentation. Thanks Leah.

[Presenter - Leah Sorini:]

Perfect. Thank you, Micah. As Micah mentioned I'm Leah Sorini and I'm a communication specialist with the Lifeline Program. I'm really excited to be here today and talk to you all about this necessary benefit. The next slide please.

With that I'm going to go ahead and get started by talking about how consumers can actually apply for Lifeline. As Micah mentioned we used the National Verifier which checks consumers’ eligibility for Lifeline, so this is our federal application system. After eligibility is determined by the National Verifier a consumer selects a Lifeline eligible phone or internet company to enroll in the program and receive service. That's a really important call out to note is that it is a two-step process. First a consumer must apply and then they must contact a phone or internet connection they’ve chosen to enroll. So a consumer can apply with a paper form because we of course know that not all consumers will have access to the internet. If they need a paper form mailed to them, they can call our Support Center and have a copy of the paper application mailed to them. They will then complete the paper form and mail it to our Lifeline Support Center for a review.

A consumer can also apply online by visiting CheckLifeline.org if they do have access to the internet. This online application is accessible from any computer or mobile device, so a smartphone, or a tablet, or a desktop. Consumers may also apply with the assistance of a phone or internet company. If a consumer already has a company in mind that they want to enroll with or they can determine which company they want to go with by using our Companies Near Me tool. I saw a question asking about which companies participate in our program. The Company Near Me tool is a great resource to utilize. It will populate a list of phone and internet companies that serve a specific area and offer the Lifeline—and that offer the Lifeline Program. After a consumer selects a phone or internet company, they will visit that company store locations or some companies will have the application available on their website. The company will collect the consumer’s information and submit the application on the consumer’s behalf.

I did want to call out that in California, Oregon, and Texas the National Verifier relies on existing state eligibility processes in these three states. So that means that the application process may vary slightly and consumers in these three states should check with their provider or public utility commission to begin the Lifeline application process. Next slide, please. With that I'm going to go into the application process online in a bit more detail. Next slide, please.

If a consumer is applying through the consumer portal which is the online application available to consumers, they would visit CheckLifeline.org. A consumer can sign into an already created application by selecting consumer sign in which is called out in the green box. If a new consumer is applying for the first time, they will look at the information that we've called out in the orange box. The consumer will select where they reside and then they’ll press get started. Next slide, please. After a consumer selects their state or territory and gets started, they will enter their personal information, so their name, date of birth and some additional information. They will then be asked to create an account, create security questions, and the purpose of this is if they forget their account credentials, they can use the security question to reset their information. And then they can indicate how they prefer to be contacted: that can be by phone, by email, or through a mailing address.

The consumer will indicate how they qualify for Lifeline. There will be a list of all the programs and then an option to qualify through income and the consumer will just select all the applicable boxes. The consumer will then have an opportunity to review their information and edit information if there were any typos or mistake. If the National Verifier could not verify the consumer’s information, so if USAC needs more information about the consumer’s eligibility or their identity, they will be notified in real time of the application errors and be provided with instruction to resolve them. After the consumer has resolved any application errors, they will review and certify to nine statements by entering their first and last initial next to each statement and it will also provide an electronic signature by typing in their full name. Once a consumer has done that they will submit the application and once they have successfully qualified, again, the next step would be to contact a Lifeline company to enroll in the program. Next slide, please.

I'm not going to go through all of the fields on the online application, but I did want to call out the address field. Applicants are required to include their primary address on the Lifeline application. However, we do have some adjustments for consumers experiencing homelessness or consumers whose home doesn't have a street number or name. If that's the case a consumer can enter what we call a descriptive address in the street number and name field. The example you're seeing here is similar to examples we've seen in the past. They should just indicate any description of where they reside. They will still need to include their city, state, and zip code, but I wanted to be sure to call out here that a street number is not necessarily required for the home address filled. Next slide please.

If a consumer enters a descriptive address, so if a consumer is experiencing homelessness or they enter another address that cannot be verified, they will just need to provide a bit more information about where they reside using the mapping tool. This is what we call the National Verifier Mapping Tool and it will try to locate where the consumer resides based on the information they originally entered and the consumer will be able to move the pin around to locate where they live and the latitude and longitude coordinates will automatically populate from the pin drop. If the consumer does know they're coordinates and that's easier for them for them finding their home on the map. They can definitely just type in the coordinates instead. Next slide, please. Now I’m going to talk about how consumer would apply through the paper form. Next slide, please.

A consumer would enter all of the same information that they're entering on the online application on a paper form. We just ask that a consumer writes clearly and using black ink in all capital letters before allowing USAC to process our paper application more quickly and ensure that we can easily read the information. And I wanted to call out that all pages of the application must be completed except page 7. Page 7 is for phone or internet companies if they are helping the consumer apply with a paper form, they know they need to fill out page 7. Otherwise, a consumer can just disregard that page. Next slide, please.

A consumer has the same option to enter a descriptive address on the paper form. However, they will also need to provide just a little bit more information about where they live if they use a descriptive address and we have the options laid out here. The first option is if a consumer has access to the internet, but does not want to submit an online application, USAC recommend that they use a mapping tool such as Google Maps to drop a pin where they live. They can print out the screenshot of the mapping tool which shows their home address and mail that into our Support Center along with a completed cover sheet. The second option would be to use a map from their communities. If a consumer is able to get a map from maybe a gas station, or their phone or internet company might have maps on hand, or if applicable their tribal government may have maps on hand. They can use a map in their community and show where they live and if they have coordinates – if their coordinates are known they should write those on the map and then they can mail that information to the Lifeline Support Center again with a completed cover sheet. Next slide, please.

A consumer may also hand draw a map to show where they live, and the image you're seeing here is an example of an acceptable hand-drawn map. The image should include crossroads, identifiable landmarks, and distances. And again, if coordinates are known the consumers should write them on the map. Again, that consumers should mail this out to the Lifeline Support Center with a completed cover sheet. I did want to call out that there are several other documents acceptable to resolve and address error in addition to what I've covered just now, but USAC thus strongly recommend that it a consumer should the enhanced tribal benefit uses one of the three options I just listed here. And that's because in order to identify a consumer lives on tribal land to receive enhanced support, USAC will need information to identify the consumers coordinate. Next slide, please.

A consumer will mail the completed application to our Lifeline Support Center at the London Kentucky address listed here. USAC will send an eligibility decision from the Lifeline Support Center, so consumers should keep an eye out for mail from the Lifeline Support Center and if a consumer’s application receives an error and they need to submit more information, the consumer will also be notified via mail from the Lifeline Support Center. Consumers should receive an eligibility decision within seven and ten businesses if they've applied through the mail and this just includes the processing time to receive the application and mail it back. Consumers can always call and check on the status of their application by calling our Lifeline Support Center at the 800-number listed here. Next slide, please. Now I'm going to go into Covid-19 relief. Next slide, please.

What I'm going to talk about now is a series of temporary program changes that you USAC and the F-C-C have released to ensure those hardest hit by the pandemic are able to receive this benefit and not [be] involuntarily removed from the program. So the F-C-C- and USAC have suspended the rules and processes listed here through November 30th. That includes recertification, re-verification, general de-enrollment requirements, unless a consumer were to request to be de-enrolled, usage requirements, and USAC program integrity reviews are all on hold through November 30th. Next slide, please.

USAC has also adjusted certain documentation requirements through November 30th to make it easier for those hardest hit by the pandemic to apply. I'm going to run through these pretty quickly. But if you have questions, please feel free to submit those in the Q-and-A and we’ll address those. We’ve made adjustment to our proof of income documentation. If a consumer need to submit income documentation to USAC, they have additional options outside of submitting three consecutive month of income documentation. Through November 30th they can also submit a notice of unemployment benefits or a notice of successfully submitted application of unemployment benefits. We are also temporarily accepting expired identification cards to prove a consumer’s identity if they need to submit documentation as long as it's expired on or after March 1st, 2020.

Lastly, we’ve provided additional relief for rural tribal consumers. Consumers living in rural areas on tribal lands may begin receiving service even if they still are in the process of providing necessary documentation, and they will have 45 Days to submit that documentation. All of this information is outlined in much more details on our Lifeline COVID-19 response web page. Next slide, please. Now I'm going to quickly go over resources. Next slide, please.

We have a state and federal partners’ webpage, which outlines key things to know for our state and federal partners. That includes information and fliers on the Lifeline Program, more information on the application process, Lifeline training opportunities, and contact information. This is really meant to be a one-stop shop for consumers – I mean for state and federal partners to pull information for their consumers. Next slide, please.

We also have a consumer website, so this includes educational material about our program created for consumers. This is also where we house to Companies Near Me tool, so again that allows for you to search for a list of companies in a specific area by zip code or city and state. It will populate with a list that you can print and the list will include all of the companies and that area, their phone numbers, their website U-R-L and what service types they offer. Next slide, please.

Our last resource is our Lifeline Team. If you email LifelineProgram@usac.org, you will be connected with a program analyst and that is where you should email information about questions about our Lifeline system, if you have requests to partner with Lifeline to educate shared consumers, or if you have a program feedback. We also have our Lifeline Support Center which is meant to serve consumers. That team can be contacted at the 800-number listed here or by email at LifelineProgram@usac.org. Our Support Center is open from 9 A-M to 9 P-M Eastern Standard Time seven days a week. Next slide, please. So again, I went through that information at the end very quickly. I just wanted to make sure our next presenters had enough time. But if you have questions, please do enter those in the Q-and-A and we will address them. And with that I'm going to go ahead and hand it over to Andy at the Colorado Coalition for the Homeless to take over the next presentation.

[Presenter - Andy Grimm:]

Great. Thank you very much. Hello, everyone. Good afternoon. My name is Andy Grimm. I'm the Vice President of Integrated Health Services at the Colorado Coalition for the Homeless, and I am going to talk to you a little bit about the Coalition and our history with telehealth and a little bit about our response to the COVID-19 pandemic. Kaylanne Chandler our director of nursing is going to join me here in the middle of the presentation. If we could get the next slide, please.

I just wanted to give a brief overview of the Colorado Coalition for the Homeless. We are a very unique organization. I like to tell people that in many places in the United States the work that the Coalition does is done by four or five different organizations. We have a mission around reducing and preventing homelessness and really the creation of lasting solutions is our ultimate focus. We also have a strong advocacy effort that we do statewide here in Colorado. We are the largest statewide Homeless Coalition in the United States. Next slide, please.

This is our philosophy of service. Ultimately, we at the coalition believe that all people have the right to adequate housing and healthcare, and we work to remove the barriers that restrict the access to those right and we firmly believe that society benefits when adequate housing and healthcare are available to everyone. Next slide.

A brief history here of the coalition. So Colorado Coalition for the Homeless was established back in 1984 and in 1985 the Coalition began providing its first healthcare services, so primary care and behavioral healthcare services in a clinic there that you can see in the photo on Stout Street here in Denver. But then the Coalition really recognizing that without housing you can only do so much and truly believing that housing is healthcare, and realizing that no one else was probably going to step up and do the construction necessary, the Coalition embarked on actually building and operating transitional and ultimately affordable and permanent supportive housing. Between 1990 and 2000 there were four hundred and seventy-two units built or acquired, and then early in the two thousand decades, in 2002, the real integration of housing and healthcare began to happen. And so here in 2014 our large new Stout Street Health Center opens where we have a fully integrated multidisciplinary care team, which I will discuss a little bit further here on the next slide.

As a Federally Qualified Health Center or Community Health Center the Coalition receives federal funding through HRSA in both the Healthcare for the Homeless and the Public Housing Primary Care funding streams. Unlike many other Community Health Centers across the country, we are specifically and only funded for the Healthcare for the Homeless and Public Housing Primary Care mission, so we do not receive any of the general Community Health Center funding that other C-H-Cs around the United States receive. Our mission is purely focused on providing services to those populations. We are the only organization like that in Colorado and there are not many around the country that have just Healthcare for the Homeless funding.

So our multidisciplinary care teams involve every type of provider you might imagine from physicians, nurse practitioners, behavioral health providers, which include licensed clinical social workers and licensed professional counselors. We also have a full dental clinic service, so we have dentists and dental hygienists and provide a full spectrum of dental services. We have an outpatient pharmacy that fills hundreds of prescriptions for patients on a daily basis. We also provide respite services for individuals who are being discharged from hospital settings that need additional care that you or I might receive as a home-based care benefit. We also provide a vision services and have a full eye clinic including optometry and ophthalmology and then also provide a full spectrum of integrated primary care, behavioral health and substance use disorder treatment, including psychiatry. We really have fully integrated healthcare model along with a full complement of supportive services: case management, peer mentors, housing counselor. And I just threw in a comment here that this integrated model of care is constantly evolving now in response to COVID-19 and in response to us to telehealth. Our model really previously was with a focus on in-person visits that we would bring all of the services to an individual patients in the exam room and rotate in our multidisciplinary team. That’s simply more difficult to accomplish now because of different COVID restrictions and it's definitely harder to accomplish that on a telehealth or telemedicine visit. Those of us who provide integrated healthcare are going to really need to figure out how to adapt this model as we move forward in the response. Next slide, please.

Just a quick overview of our data here, so we did serve 15,204 unique individuals in 2019. We're on track to probably get to around 16,000 individuals served this year. And that's for all of our integrated healthcare services and supportive services that come under our Community Health Center program. Just a quick breakdown that kind of our medical dental mental health and vision numbers and of note 95% of the patients that we serve are over 18 and older and, as a Healthcare for the Homeless provider, that is something that we appreciate and don't want to see homeless children have to seek her services. We really are focused on the adult population. Next slide.

You heard me mention this phrase earlier in the talk here, but we truly believe that housing is healthcare and that, unless someone has a roof over their head and a place to call their own, their healthcare goals are never going to be able to be fully met. That is a photo there of our Stout Street Lofts. So the Stout Street health center, which is our largest health center, is on the first two floors of that building and then on the top three floors of that building are apartments that are permanent supportive housing that we own and operate as a property manager. Next slide.

As I mentioned, we are both a property developer and then property manager for affordable and permanent supportive housing across the Denver metro area. We currently have 19 properties and last night we slept a little over 4,000 individual households in the permanent support of that affordable housing that we operate, and we really combine low-barrier housing, health care, and supportive services as a fully-integrated model to help support people in staying in housing once we’re able to get them housed. Next slide.

And I in order to help people remain housed, we provide a vast complement of support services that you can see here. Everything from case management and vocational programs. We have different benefit acquisition assistance. We do street outreach, provide other community resources. It's really important to wrap all of those services around people so they can be successful in staying housed and meeting our health goals. Next slide.

This is our Fort Lyon Supportive Residential Community. It is a historic former V-A hospital campus. It's on 500 acres in Bent County in rural Southwest Colorado. This is a place where individuals experiencing homelessness from across the state of Colorado can leave the community in which they're struggling with substance use disorder and homelessness and go to this campus for up to two years at no cost to them to help them recover from their substance use disorder and get their health and other life challenges more stable and the ultimate goal of this program then is to place people into a permanent housing solution after they graduate from the two-year program or sooner if that is something that they can meet through their goals. Next slide.

So the big challenge with Fort Lyon is that it is over three hours away from all of the other Colorado Coalition for the Homeless Denver-based services. So I just put a map up there so you can get a sense of how far out in the middle of rural Colorado that location is. so that location and really a lack of in-person connection to other providers has always made provider recruitment challenging at the Fort Lyon location. We have a Community Health Center site on that campus that provides services to the people living on the Fort Lyon campus, but is also available to former program participants and other members of the community who might be experiencing homelessness. And so, we provide primary care, behavioral health including psychiatry at that location.

Next slide. Prior to-- I'm sorry can you go back one slide. I'm getting into Kaylanne’s slides here. Prior to 2019, the only telemedicine services that the Coalition was providing were to connect a psychiatric nurse practitioner or psychiatrist from our main Health Center location in Denver to the rural Fort Lyon Clinic location. And we did that a couple of mornings a week. Generally, that was not a reimbursable service in Colorado for a Federally Qualified Health Center, but there was just no way for us to recruit a provider, particularly a psychiatric provider, and give them a meaningful opportunity to be successful in such a small rural community. The same thing really goes for our recruitment of primary care providers, which will get to here in just a moment. I'm going to turn this over to Kaylanne Chamber our Director of Nursing so she can talk about our current telemedicine efforts.

[Presenter - Kaylanne Chamber:]

Hello everyone. Thank you so much for having us on here today to speak and so just picking up where Andy left off then. Moving into our telework efforts, we’ve been really creative in our funding sources as a community health center and as a nonprofit that works with healthcare and housing, especially the population of people experiencing homelessness. We first— and diving in the telemedicine route – didn't know exactly what the reception would be with our patient population and how much they would be interested in this mode of technology, and so this Nurse Education, Practice, Quality and Retention Grant we got that funding started in July of 2018. It's a four-year grant through HRSA, the Bureau of Health Workforce, and it is a four-year training grant really working on nursing workforce and training up nursing students to pursue careers in primary and community health care. Next slide.

And you know we are a unique organization with this recipient because a lot of the funding recipients were on the university side, but as the community health center we really use that grant to do all of – these are our goals for this grant, these objectives here, and as you can see the second to the last line really, one of our goals is to increase the percentage of satellite health center site patients who can access integrated healthcare service through the enhanced R-N role, including creating a mobile telemedicine program for nurses. What we did is we really wanted to train our nurses in the workforce to help get our care and our access out of the traditional walls – four walls of our clinic spaces and really pilot this work in technology and see if it works for our population. Next slide.

Another funding source that we were able to creatively use to also help support some of this work is through our Prime Health Innovation Challenge in 2018. If you go to the next slide, it tells a little bit more about this. But this is again through the Colorado Health Foundation. So both of these were different grants and this one funded Prime Health Annual Innovation Challenge, C-C-H actually served as a judge in a host organization. They had a sharktank-like event where we were able to partner with Care on Location to use their $50,000 reward to advance or telemedicine effort. And Care on Location has been a critical partner in helping us. They actually provided and put together some of the technology options for us to trial some of these initiatives across the diaspora of people we are serving here. Next slide.

Going back to that primary care at Fort Lyon, this was our pilot project here. We really used it in this rural area to see if folks were interested in utilizing telemedicine services on the patients’ side, to see if our nurses and M-As could really work together to make this resource valuable, and if it really did help a provider retention and recruitment efforts to really get care access out for this location. and one of our challenges is always been not until our COVID response, as a Federally Qualified Health Center in Colorado, we were not eligible for Medicaid reimbursement for telemedicine and so that was why it was difficult up until more recently to kind of fully, full force go towards these efforts because, of course, reimbursement is critical. So what we could do and how we could help some of this grant funding support this work was wonderful, but again until recently those services have been reimbursable. Next slide.

This is a picture of our telemedicine setup at Fort Lyon and the providers and the nurses, the whole integrated care team, learning how to use it from the patient's side. And also, of course there’s the provider’s side. Next slide.

This slide is a picture of our telemedicine backpack. so once we realize that it did work well at our Font Lyon Health Center, the next place we wanted to trial our telemedicine efforts was on our Street outreach teams, because we know that people experiencing homelessness, again when they have belongings or if there is, you know, limited trust or engagement with healthcare services, but they still needed – there's a lot of care needed on the streets and so we actually paired again with Care on Location to develop these backpacks that our nurses were carrying out on the street to see people – to connect when people are on the streets to connect right to people in our clinic, beam in with whatever services they need and to reform demand access. Next slide.

This is one of our nurse coordinators demoing the backpack here. And again, the nurses really love this because they're able to offer a higher level of care out on the street and our healthcare providers really love it because they're able to see more people that traditionally wouldn't be able to make it into a clinic setting, and it really fulfills this concept of meeting people where they are. We were interested – you can move to the next slide. We were interested in this street outreach again to see if clients really would want this level of service or not. Again, you're out on the street – there are potentially privacy concerns on the side of the patient; we didn't know if people would really want to engage with a provider on the screen rather than in-person building that trust, and one of the things we found is that nurses bringing the backpack out really bridges trust and people actually wanted immediate access and really were excited about this pilot really wanting – were asking for this resource more and more, more than we even realized. Because of that the State of Colorado Governor's Office of E-Health Innovation actually awarded us an innovation award to expand this use of backpack because we did see how effective it was and we need more funding to fund the backpacks. So now we're actually going to be spreading it and not just to nurses, but to M-As and our case managers around the community. This is one of our nurses in a housing unit, somebody doing—treating this woman for wound care and cellulitis because she's having mobility issues to come in for clinic. Next slide.

COVID has really increased our telehealth efforts again. For one it’s been more critical than ever to have socially distant health care and also provide people health care in their homes so that they can safely isolate as needed. And so we have been, again with our housing units, we've been providing telemedicine services. And then also we – with COVID, these services become reimbursable which is amazing. I’ll let you read through these in detail since I know we're pushing up against the end. Next slide. This webinar is recorded, and you will all be provided with slides.

Our Activated Respite and Protective Action response during COVID-19 has been in partnership with the city of Denver and with multiple other nonprofits. We did create and an Activated Respite hotel where people experiencing homelessness could isolate and quarantine based on a positive test of COVID-19 so it's not spreading to congregate shelters. And then we also created some Protective Action rooms, which are about 600 hotel rooms where people who are at highest risk of COVID can go and isolate themselves as they have no way to protect themselves on the streets. Next slide. And really, again, we have really piloted a lot of this backpack work and telemedicine work in these hotel rooms because, again, we just want to limit the high-risk face-to-face contact and we want to make sure we were offering full healthcare services to these people who are high-risk. Last slide here is that next one.

Our key takeaways, I would just always encourage you to be creative. We have made so much progress here at C-C-H, just been asking clients what they prefer, doing client surveys, asking staff what they need, looking at our recruitment and retention, looking at barriers to care, and then also looking for regional opportunity, local opportunities, like the Prime Health Challenge, for federal grants, for state level grants that will provide services that can fund some of these telehealth and these initial setup costs for this technology. And really, like I said, people want to be met where they are. If we go and – if we get out of some of the traditional realms of healthcare and ask people what they need, I think we're always surprised here at C-C-H and I’d encourage everyone on this call – I think it's continually surprising to know what people actually want versus assuming what we think they will need or what they want in terms of access to care. So that's that and on this note I will hand it back over to Cheryl for the final minutes.

[Presenter - Cheryl Levine:]

Hi, thanks this is Cheryl from H-H-S. Thanks to our amazing speakers. We have just a couple minutes. I'm going to throw a couple questions out there. We’ve captured all your Q-and-A we’ll have an accompanying resource to cover that when we put up the recorded webinar. Back to F-C-C just a couple things for following up. Can you maybe give some clarification about, for an individual experiencing homelessness who doesn't have an address it – can you give us any more information about how they could provide that hotspot? And if there are any more information about tribal or persons who are living in cities not tribal lands, thanks?

[Presenter - Micah Caldwell:]

This is Micah and I’m going to differ to Leah in the first question with respect to the application. I think she's described that to some extent when she was going through the application process about the alternative there if you don’t have an address.

[Presenter - Leah Sorini:]

Hi, this is Leah. To answer the first question, great question. I did want to clarify that providers, so the Lifeline companies will also – the Lifeline companies will be the ones responsible for providing devices to actually receive this service. So questions about the hotspot or how consumers will receive service – that is something that the consumer will need to speak with their provider about. In regards to consumers experiencing homelessness: yes, as I did mention on the application itself consumers do have the option to include a descriptive address to indicate where they reside; however in regards to receiving communication from USAC about the status of your application, they have the three options. So they can do a phone number, an email address, or a mailing address. So if a consumer is experiencing homelessness and has occasional access to the internet, including their email may be a good option here. Another option would be if they visit a shelter frequently or another support service that they are able to receive mail at that would be a good option to include for the mailing address. And then lastly of course, we know that not all consumers do have access to the internet, but the way to receive the quickest response would be applying online and receiving an eligibility decision online. So if a consumer’s able to maybe get access at a public library or again do another support service that would be a really good option for a consumer to submit an online application.

[Presenter - Cheryl Levine:]

Okay. Thank you so much, Leah. Thanks again to our speakers. Great topic. Really interesting promising practices and programs. We are out of time. We'll put everything up on the web for you to be able to get these resources at a later date on our webpage. We say thank you. Thanks to everyone. Thanks to our speaker. Thanks to our participant and thanks to our partners. Have a great day.

[Presenter - Operator:]

And that concludes our conference. Thank you for using Event Services. You may now disconnect.

[The webinar ends.]

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  • This page last reviewed: October 19, 2020