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NC Continues Work to Assist People Living with Mental Illness to Find Housing, Services

Raleigh

The North Carolina Department of Health and Human Services submitted an annual report to the legislature on Nov. 8 highlighting significant progress in the Transition to Community Living Initiative (TCLI) to assist people with mental illness find housing and services in the community. A hallmark success of the program was a 27 percent increase in housed individuals over the prior year.

The initiative was created in 2012 as part of the settlement with U.S. Department of Justice in response to an allegation that individuals with serious mental illness were inappropriately served in adult care homes. The settlement also provides that people being discharged from state psychiatric hospitals should have greater opportunities to live and work in the community.

“The TCLI program is key to our Behavioral Health Strategic Plan released by the department in 2018 which aims to integrate care and increase the richness of our community levels of services,” said Kody H. Kinsley, Deputy Secretary for Behavioral Health and Intellectual and Developmental Disabilities. “Our vision is for all persons with disabilities to live, work and thrive in their communities to the fullest of their abilities.”  

The annual report highlights several successes. On June 30, 2019, the initiative had a total of 2,114 participants in supportive housing, which exceeded last year’s total by 27 percent. These gains position NCDHHS to exceed its goal of assisting 3,000 TCLI participants to obtain supportive housing in communities by the end of the settlement. Additionally, a new Referral, Screening and Verification Process (RSVP) tool was implemented for participants. RSVP removes a barrier to community integration by diverting people from settings that may be inappropriate for their needs. The tool also engages Local Management Entities/Managed Care Organizations (LME/MCOs) in providing vital, community-centered assistance. The adoption of RSVP helped increase diversions by 14 percent statewide. 

On Oct. 26, the program’s independent reviewer released a separate review of the TCLI program. This report noted that the initiative met its annual housing requirement for the first time since 2014. The independent reviewer noted also that NCDHHS has provided leadership to improve the management, budgeting and oversight of the program. With the number of referrals to the TCLI program continuing to rise, the independent reviewer cited the need for continued improvements in services, discharge and transition planning, quality assurance and performance and underlined delays in pre-admission screening and diversion.

“Collaboration with LME/MCOs and the NC Housing Finance Agency has been key to our success,” said Sam Hedrick, TCLI Director and Senior Advisor on the Americans with Disabilities Act. “Our person-centered approach to service delivery and supportive housing program is assisting high-risk individuals to attain health, employment, education and well-being.” 

North Carolina's progress in achieving the goals of the TCLI settlement is measured in six areas: (1) supported housing; (2) pre-screening and diversion; (3) quality assurance and performance improvement; (4) supported employment; (5) discharge and transition planning; and (6) community mental health services.

The NCDHHS annual report assesses substantial progress in the first three of the six areas and acknowledges that significant effort continues under all six areas. This is a meaningful leap forward from the previous year’s annual report, which highlighted some improvements but none of the six areas with substantial progress. NCDHHS has until 2021 to achieve its goals in all six areas and is committed to building on present momentum and working with all its partners to do so.

For more information on the TCLI program, please visit: www.ncdhhs.gov/about/department-initiatives/transitions-community-living-initiative.

The department’s annual report is available at www.ncdhhs.gov/documents/annual-reports-transitions-community-living-initiative.

The independent reviewer’s report is available at https://files.nc.gov/ncdhhs/documents/files/2019.

The Behavioral Health Strategic Plan and Vision for the Future is available here: www.ncdhhs.gov/news/press-releases/dhhs-releases-vision-future-behavioral-health.