Healthcare for the Homeless - Houston

2012 Annual Report

HEALTH | HOPE | DIGNITY

Leadership CEO - Frances E. Isbell, MA 2012 was a whirlwind of activities and changes – some fun, some challenging – all exciting! Many of the changes were in response to initial health reform mandates and a new Medicaid program in Texas. Although most of these changes add complexities of paper work, the staff responded with a willingness to do whatever it takes to provide the best possible care for our patients. At the same time, we were entertained by some much lighter events: Music Doing Good chose HHH as a recipient of one of their fundraising concerts and singer Jon Wolfe performed a benefit for HHH. Les Alexander joined the annual mail campaign with a $100,000 challenge pledge, thereby securing the most successful campaign to date. I am grateful for the regard Houston has demonstrated for our work, and for the people who make it possible: our staff, the Board of Directors and our many financial contributors. Thank you for making it a joy to come to work each day!

2012 Services Snapshot FIVE-YEAR HISTORY

2008 2009 2010 2011

Unduplicated Clients

8,674

9,634

10,202

Patient Visits

14,240 19,268 21,995 19,619

21,400

Units of Service

56,700

81,169

Veterans Veterans 26% Non-veterans 74%

Gender Female 39%

President - David. S. Buck, MD, MPH Most care for the mentally ill is provided by primary care physicians. Less than 50% of patients referred to a mental health specialist make it to their appointment. For indigent mental health care in Harris County it can take more than six months to obtain care. We know that homeless patients with untreated mental illness experience poorer health status, higher inappropriate utilization of healthcare, higher mortality, and increased cost. Across the country there has been a shift towards embedding mental health services into primary care, and to provide patients with more integral and coordinated care. These practices have resulted in better health outcomes and decreased cost across the system. We at HHH are embarking on this new embedded model so there are no empty referrals or promises. Thank you for your support.

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2012

Male 61%

8,810

71,471

10,170

71,010

80,055

4,219 individuals received medical services in one of HHH’s three primary care clinics 976 individuals were served during street outreach 920 patients received dental care 5,152 individuals were linked to services via the Project Access transportation program 397 mentally ill homeless inmates were contacted while in the Harris County Jail for linkage to care post-release 203 individuals were provided with vision screenings, glasses and/or referrals to specialty care during HHH’s biannual Vision Fairs

Most Common Diagnoses in 2012 • Severe Mental Illness • Hypertension • Diabetes • Drug/Alcohol Dependence • Dental Disease • Upper Respiratory Infection

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The mission of Healthcare for the Homeless – Houston is to promote health, hope and dignity for Houston’s homeless through accessible and comprehensive care.

The mission of Healthcare for the

Homeless – Houston is to promote health, hope and dignity for Houston’s homeless through accessible and comprehensive care.

Our History Healthcare for the Homeless – Houston (HHH) was founded in 1999, incorporated in 2000 and designated Houston’s third Federally Qualified Healthcare Center (FQHC) in 2001. What began as a two exam room clinic with an adjacent dental chair more than a decade ago has expanded to three integrated care clinics throughout mid and downtown Houston, a In 2012, donors enabled HHH to provide more three-operatory dental clinic, a street outreach than 10,200 homeless program, jail and hospital inreach initiatives men, women and and a first-of-its-kind transportation program. children with essential and stabilizing care. Our patients are among our community’s most vulnerable – including women and children fleeing domestic violence, those who suffer with severe mental illness and those who struggle to break the cycle of chronic homelessness.

How We Do It HHH operates with a unique model of care which promotes a highly collaborative system that addresses the often complex health and social needs of this underserved population. Clinic sites are located within SEARCH, The Beacon and the Star of Hope Men’s Development Center. Street outreach is provided at the Way Station located in the courtyard of Palmer Memorial Episcopal Church and inreach services are provided at Ben Taub General Hospital and for mentally ill homeless detainees at the Harris County Jail. HHH’s newest initiative is an extension of the Jail Inreach Project that works collaboratively with Angela House in providing prostitution recovery services based on trauma-informed models of care. VOLUNTEERS In 2012, 462 student and professional volunteers contributed 14,875 hours of service for an in-kind value of $361,971.

What We Do HHH is a “safety net” provider that seeks to bridge the gaps in the current healthcare system through the provision of highly integrated healthcare and supportive services. Primary care, psychiatry, mental health counseling, substance abuse counseling, medical case management and outreach services are provided to individuals and families living on the streets, in emergency shelters or in transitional or supportive housing. 4

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HHH operates three integrated care clinics that individually serve a specific niche for the homeless community and collectively strive to meet the unique needs of various sub-populations of homeless individuals.

The largest and original clinic located within the SEARCH building provides a full scope of services for a broad spectrum of homeless individuals, many of whom are also utilizing services such as meals, showers and laundry at SEARCH. HHH’s clinic located at The Beacon (the Cathedral Clinic) functions in several specialized ways. It operates a Women and Children’s clinic that is sensitive to the specific needs of this population, who are often homeless as a result of domestic violence. It offers a confidential space accessible from the street, rather than through an often crowded male-dominated day shelter, and operates with a staff of female providers. The Jail Inreach Project is also housed at this location, which is conveniently located just blocks from the county jail. The student managed clinic (HOMES clinic) and the Podiatry Clinic operate from this location offering weekend access to care. The clinic located within the Star of Hope Men’s Development Center specifically serves clientele being sheltered at that facility. The HOMES Student-Managed Clinic

The HOMES Clinic is an interdisciplinary clinic housed at the Cathedral Clinic and managed by students from Baylor College of Medicine, UT Medical School, UT School of Public Health and UH Colleges of Social Work and of Pharmacy who are overseen by professional, licensed clinical volunteers. Since its inception, it has provided hundreds of students an opportunity to interact with homeless patients in a way unavailable in any other healthcare setting.

The Podiatry Clinic

The podiatry clinic was born from the dedication of a volunteer doctor and is open on Saturdays at the Cathedral Clinic location. It provides highly specialized services that tend to be the most inaccessible yet crucial for those who are homeless, exposed to the elements and often cope without clean socks or shoes... or without socks and shoes at all. George Sayre Dental Clinic

The three-operatory dental clinic provides urgent and routine care and restorative services as part of the comprehensive care model on which HHH is founded. It is the only dental clinic in the city A smile truly does of Houston that provides these services exclusively to change a life. homeless men and women at no cost to the patient.

BEFORE & AFTER PHOTOS BY HHH STAFF.

Clinics

In 2012, HHH worked with Houston Community College to establish a formal clinical rotation for Dental Hygiene students in the HHH dental clinic.

The Women and Children’s Clinic

The Women and Children’s Clinic serves one of the fastest growing segments of the homeless population. Tuesdays at the Cathedral Clinic are dedicated specifically for women and children. During that time, female providers work with patients in a way that promotes a feeling of safety and attention to their particular needs.

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84% of families experiencing homelessness are female-headed, and domestic violence is the main cause of women’s homelessness.

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Additional Programs The Jail Inreach Project

Jail inreach project case manager George Bement, walking with clients to the Cathedral Clinic.

Despite the fact that jails are not designed to be healthcare facilities, “The [Harris County] jail’s medical budget is $47 million a year, and more than half is used to provide mental health experts, purchase and dispense psychotropic medication, as well as train and pay salaries for jail staff who are assigned to work with the mentally ill” (Houston Chronicle, March 2013). This makes it the largest provider of mental health services in the state of Texas. More than half of inmates receiving mental healthcare in jail are homeless.

The Jail Inreach Project provides an avenue for those who are mentally ill, homeless and cycling through the criminal justice system access to services that help break this cycle. Rarely do those who are receiving primary and mental healthcare while in jail have provisions for continuity and access to care post-release. This often causes lapses in treatment followed by rapid deterioration on the streets/shelters and subsequent reincarceration or hospitalization. This program provides immediate access to Those engaged in the program for continuity of care upon release. Participants often at least one year choose a daytime release to the care of their case have experienced manager, who meets them at the jail at the time a 64.8% reduction of their release and literally walks with them to in average days per year incarcerated the Cathedral Clinic for immediate continuity of and a 57.1% care appointments with medical and behavioral reduction in arrests. healthcare providers. Vision Fair

Every June and December, HHH provides vision assistance, including eye exams, glasses and referrals to specialty care, as needed, through the Vision Fair, which is staffed entirely by volunteers. Project Access

In 2002, HHH began operating a 42-passenger, wheelchair accessible bus on a route between 21 homeless and social service agencies. It exclusively provides transportation for more than 5,000 homeless Houstonians free of charge each year. Last year 44,691 rides were provided. Project Access was the first program of its kind in the nation and is now being duplicated in other cities.

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Each year about 200 patients receive these services.

“It doesn’t matter how good the services are, if you can’t get there, it’s like having no healthcare at all.” Joseph Benson, HHH Staff and Chair of the Consumer Advisory Board

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Thank you

to the generous donors who make our work possible

$500,000+ HRSA/Bureau of Primary Healthcare $250,000-$499,999 Houston Endowment Inc. The Methodist Hospital $100,000-$249,999 Les Alexander and the Houston Rockets Gilead Sciences Foundation - HIV Initiative State of Texas Emergency Solutions Grant City of Houston CDBG $75,000-$99,999 [none] $50,000-$74,999 The Cullen Trust for Healthcare Gilead Sciences Foundation Harris County Community Services Dept. - CDBG The Hamill Foundation $25,000-$49,999 Baxter Trust Cardinal Health Foundation Rockwell Fund, Inc. St. Luke’s Episcopal Health Charities The Brown Foundation, Inc. The Frees Foundation $10,000-$24,999 William and Maria Boyce Bank of America Foundation Larry and Katherine Buck Cameron Foundation The Congressional Club Doris and Floyd Kimble Foundation Hamman Foundation Harris County Sheriff ’s Office John P. McGovern Foundation The Lewis and Joan Lowenstein Foundation US Trust/Bank of America Charitable Gift Fund Robert and Edith Zinn 10

$5,000-$9,999 Baylor College of Medicine - Student Gala CGGVeritas Huffington Foundation Marlene Marker David and Terri Mendez Kendall Montgomery Dr. and Mrs. Hisashi and Lynn Nikaidoh Perry and Bunny Radoff Texas Bar Foundation Lola Wright Award honoring Fred Hagans The Reso Foundation Vivian L. Smith Foundation Donald Zuker $1,000-$4,999 Ann Al-Bahish James A. Baker III George Bement and Barbara Strobel David S. Buck MD, MPH and Susana McCollom Cardinal Health Foundation Volunteer Leadership Award Lynn Vogel and Lynn Carter John and Cecilia Colucci CRC Family Charitable Foundation John Dickerson Robin and Glen Eisen Fluor Foundation Employee Giving Campaign Matching Funds Aida Gill Morris Glesby Gulf Coast Combined Federal Campaign Dr. Wanda Henao Kristen Henry SEI Investments Hilda & Hershel Rich Family Fund Houston Endowment, Inc. Matching Grant Frances Isbell KBR Employee Giving Matching Funds Craig and Debra Kercho Nat and Mike Levy Richard and Andrea Link Vincent “Trip” and Traci Marable

Donors Drs. David and Naomi McCants Edward and Jennie Miller Hector Pineda Mrs. T.R. Reckling III Bradley and Daisy Lee Roe Dana and Gene Sellers Ed and Susan Septimus Dr. Jeffrey T. Sherer Gregory Tompkins Mark D. Troth Kevin and Ronnie Whelton Mark and Nancy Wozny Ed and Lorraine Wulfe $250-$999 Amerigroup Texas Ilir and Nancy (Chen) Bajraktari Jack and Ginger Blanton Leslie and Jack Blanton, Jr. Carlie Ann Brown Kay Carr Chevron Humankind Matching Gifts Juan and Rosa Contreras Kimberly Cotner and Scott David Dr. and Mrs. Joel H. and Shelly Cyprus Kay Davidson Scott and Andrea Davidson Jeff Dodd Andrew Edmonson Erla and Harry Zuber Fund Doe Florsheim Dr. and Mrs. Jan and Martee Fuerst Dr. Anthony Greisinger Emily Griffin Dr. Horacio Guzman William D. Hanna Amanda Hanson Landra S. Harris Sara Haynes Gloria L. Herman/Herman Family Fund Bob and Cynthia Holloway Thomas and Csilla Horvath Dr. and Mrs. William Huang IBM Employee Charitable Campaign Demetra Johnson Tony Laudin Anna Leal

Carolyn Litowich Dr. Mary Lucien Lynch Donald and Judith McCullough and Family Erin Meade Julia Olivas Dr. & Mrs. Bob and Susan Parkerson Alice E. Pratt Paul and Sarah Sarahan Marlise C. Skinner Greg and Lisa Spier The Houston Walk for Mental Health Awareness David and Candace Weinstein Dr. Cynthia Zinner $100-$249 Stuart and Barbara Aaron Jack and Karen Absher Tom Allen Matt Baker Lary Barton Barry Franklin Baxter Mr. and Mrs. Robert Bixby Major and Susan Bradshaw Steven Hecht and Deborah Brochstein Ken Burke Victor and Lynley Cardenas Daniel F. Castaneda Dr. Alec C. Chou Dr. Joseph Colquhoun Paul Danziger Victor V. Dizon Caron Lee Drake Donald Yurewicz and Theresa Einhorn Molly and Ron Ellis David and Diana Erani Annette Eriksen Lori and Allen Feezor M.M. and Carole Feld, Jr. Kimberly Fontenot Marcia Forbes Drs. Philip D. Scott and Susan Gardner Jeanette and Philip Getz James A. and Sherri H. Glover Alan and Rita Sue Gold Martin Grady Kate Graham

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Donors Alan Buck and Roslyn Hager Dr. Richard H. Haines Dr. and Mrs. Roger G. and Ardyth J. Hanson Robert and Dorothy Harris Ernest and Barbara Henley Sheleika Hervey Janice L. Hewitt James E. Hightower Dr. Vivian Ho Robert M. Hopson Kirsten Johnson Vicki Jud David Kaplan Julie Keeton Peter and Kristy Kiernan Mary Stewart Krosby Natosha LaCour Dr. and Mrs. W. Pennock Laird Irwin Lee Marc Levinson Dr. Judy Levison Richard and Rose Lee Link Alexandra Lowe Drs. Arlo Weltge and Janet Macheledt Dr. Shelley D. Manning Michael D. Masera, DDS Carol Mayes Dr. Monique McKnight Frank and Kathleen Meade Gabriela Guzman Meade Dr. Joseph Merrill Tom Mitchell Leslie Montante Robert G. and Judith D. Mood Kenneth M. Moore, Jr. E. Eileen Penland Constatine Petrou Thomas Pierrel Steve Quill - Travels Revealing Understanding Trust Hope Susan Rasmussen Alan and Lynette Rauch Mansel and Brenda Rubenstein Sally Bell Rutherford Neal and Joyce Sarahan Brian and Heather Sasser Herman J. Schultz

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Greg and Iva Smith Dr. Cheves Smythe St. John’s WELCA Dr. Alton and Emily Steiner Dr. and Mrs. Howard Sussman Burnham Terrell The de Hartog Trust Shirley Toomim C.G. and Rose Mary Tyner Mr. and Mrs. John and Mary Tyska Dr. and Mrs. Steven and Jennifer Vaughan Lori Warner Charlene and James Wilke Evelyn Wisenberg Chris and Cherie Wyatt $1-$99 Cidney Aae Dr. M. J. Alo AIG Matching Grants Program Ruth Alpert Anonymous Anonymous Tonnie Beck Joseph Benson Barbara Boyett William Paul Brown Jennifer Schaffer and Rachel Burnett Marilyn Caplovitz Tina M. Clayton Susan Crawford Avril and Julius Danziger Melvin and Frieda Dow Sumarie L. Dowden Dr. Jennie A. O. Duffy Mary Dusing Ella Renee Fillingim John Flanagan Susan Floyd-Toups Muriel Selber Folloder Dr. and Mrs. Aaron Fradkin Michaeline Frost Julie Takahashi and Sarah Golden Dr. Harold N. Haber Wesley Hall Sandy and Helen Havens Jean Haws

Donors Matt Howard Bobbie A. Huebner Brandy Roberts and Misty Jatzlau Aurelia Johnson Frances Jolly Mr. and Mrs. Lester Kastleman Samuel & Cecile Keeper Dr. Catherine Kerr Austin Kinghorn Bernard and Marylu Levy Arlene Levy Dr. Thomas Lin and May Sim Jennifer and Mario Macia Dr. Ronald Lee Maddox - Lauder Road Dental Center, Inc. Cheryl Mellenthin Dr. and Mrs. C. Hunter Montgomery Carnell Moses CM Transport LLC Dr. and Mr. Melanie and Kamran Mouzoon Irileria Muhammad Maureen O’Connell, OP Enzo Pera Brett and Michelle Perkison Long Pham Charles and Joann Philpott Pin Oak Middle School Danielle Ranneft Harry and Sue Rosenzweig Lynn Rubinett Safeway, Inc. Sheila Shaw Rhonda Stratton Susan Taylor Marene Thomas Joy and David Turkel Carlisle Vandervoort Marcelyn Vener Ruth W. Walkow Mary Wallett Talia Washington Vicky Weiman Christy L. Williams Kimberly Young-Payne Tega Zoma Dr. and Mrs. Fred and Melody Zuker

In-Kind Donations Alliance of Baptists Americares Arthur Murray Dance Studio Blanco’s Jessica Brooker Dr. David S. Buck Dr. Arch Carson Chapelwood United Methodist Church Christ Church Cathedral, The Beacon Churrascos Restaurant John and Cecilia Colucci Courtroom Concepts John Dickerson Direct Relief USA Michael Dobbs Jackson Gilmour & Dobbs, PC Billy and Elisabeth Dyer Virgil Fry Panos and Tricia Georgiou Dr. Anthony Greisinger Dr. Horacio Guzman House of Pies Houston Community College Tracie Jae Misty Jatzlau and Brandy Roberts Kelsey Research Foundation KPRC-TV Lifeline Chaplaincy Medical Bridges NRG Energy Texas Carolyn Passada Pizzitola’s BBQ Dr. Pauline Rosenau and Neil White Brian Sasser Fred and Wendy Schiller SEARCH Dana and Gene Sellers Serente Spa Shana Ross Fitness Star of Hope Men’s Development Center Stout Risius Ross, Inc. Stephanie Stroud The Methodist Hospital UH Mobile Eye Institute United Airlines Dr. Donald Witt Jon Wolfe Sandy Zeutschel, Locke Lord LLP 13

Leadership

2012 Financial Statement

Board Chair - William “Bill” Boyce This past year has seen increased awareness of the high price paid by homeless individuals and by communities when homelessness goes unaddressed. Awareness is a good thing, but it is not a substitute for action. For more than a decade, HHH has acted to address this need at the precise location where homelessness, poverty, physical illness, and mental illness intersect. We thank the many generous donors, staff, and volunteers who support HHH’s mission and help HHH live up to the promise of its name. The commitment of individuals, foundations, and corporations supporting HHH is crucial; without that commitment, HHH could not fulfill its mission to promote health, hope and dignity for Houston’s homeless citizens. Thank you for sharing in this important work.

Board Of Directors Roster - 2012 Ann Al-Bahish - Honorary Chair Matthew Baker Joseph Benson William J. Boyce - Chair John Colucci Scott Davidson - Vice-Chair John Dickerson - Treasurer David Finn Kim Fontenot Horacio Guzman, MD Thomas C. Lin, MD

Erin Meade Edward Miller Tom Mitchell Kendall C. Montgomery Maureen O’Connell Hector A. Pineda Bradley A. Roe Brian Sasser Janice Suchyta Talia Washington Kevin Whelton - Secretary

Programs ...................................................................................... $ 267,648 Individuals.................................................................................... $ 255,972 Corporations................................................................................ $ 22,645 Federal & State Grants & Contracts.......................................... $ 1,068,763 Private Grants.............................................................................. $ 1,433,949 In-Kind- Contributions.............................................................. $ 609,980 Other............................................................................................. $ 26,600 Total Support & Revenues................................................. $ 3,685,557

EXPENSES AND LOSSES

Direct Patient Care...................................................................... $ 399,236 Labor............................................................................................. $ 2,260,775 Professional Fees.......................................................................... $ 21,945 Board, Staff & Committee Spt. Recognition............................ $ 16,989 Fundraising Events...................................................................... $ 27,323 Insurance...................................................................................... $ 22,100 Computer Software & Support.................................................. $ 82,029 Equipment & Facilities............................................................... $ 287,127 Other Costs.................................................................................. $ 37,581 Project Access.............................................................................. $ 134,424

Associate Board Kay Carr, Chair Emerita Rena D’Souza, DDS, MS, PhD Anthony Greisinger, PhD, Chair Emeritus Davis Hull David Kaplan

SUPPORT AND REVENUES

Marc Levinson Donald McCullough Dana Sellers, Chair Emerita Tina Smith Carlos Vallbona, MD

Total Expenses........................................................................ $ 3,289,529 Support and Revenue Over(Under) Expense.......................... $ 396,028 Temporarily Restricted Net Assets............................................ $ (325,000) Increase (Decrease) in Unrestricted Net Assets...................... $ 71,028

Advisory Board Lary Barton James Calaway 14

Jack Dulworth George Sayre, DDS

*Unaudited

**Temporarily Restricted Net Assets include multi-year grants that are booked as a receivable at the time of commitment. 15

PHOTOS: FELIX SANCHEZ PHOTOGRAPHY

P.O. Box 66690 • Houston, Texas 77266 • www.homeless-healthcare.org • (713) 276-3073