Collaboration for the Reintegration of Formerly Incarcerated Individuals

In New York City the Fortune Society's Coming Home Project (CHP) addresses challenges for re-entry of People Living with HIV/AIDS leaving correctional institutions and returning to their communities. This project began receiving HOPWA funds in 2003 as a Special Project of National Significance and was recently renewed in 2010 with a grant of $1,146,365 over the next three years. The primary goals of the project are to place and stabilize clients in safe, appropriate, permanent, and affordable housing. Fortune Society integrates CHP with other programs that it runs to allow for a seamless continuum of service. In tandem with their Rikers Island Discharge Enhancement Program, case workers enter the prison system and encounter inmates prior to discharge and provide information and referrals to those who request it, including to the Coming Home Project. Outreach is also done with parole officers and in homeless shelters. The CHP recognizes the importance of connecting with the local government officials and has built strong relationships with the City’s Parole, Probation, and a variety of other government service providers in the correctional system. This relationship allows Fortune Society access to eligible clients prior to their release from prison and prevents homelessness by linking soon to be released inmates with the care and services they need to make a smooth transition back into society.

Clients enrolled in the CHP program benefit from Fortune’s holistic approach to helping clients attain and maintain independent housing. Housing has been identified as the base to stabilizing clients and connecting them to care. In the intake interview CHP staff determines whether the client is in need of immediate housing placement and if so arranges for emergency/transitional housing to stabilize the clients so that they can receive other needed supportive services with a goal of placement into permanent housing.

Clients are assigned a housing specialist/case manager meet with their clients on a regular basis to assist them in coordinating needed services and supporting them in the lifestyle changes necessary to avoid high-risk behaviors that compromise their health and freedom. Interdisciplinary case conferencing between housing specialists, case managers, counselors and other supportive staff are conducted on a regular basis to ensure the smooth coordination of services and are fundamental to the individualized support that clients receive. Through a case management approach, CHP staff links clients and their families to medical care and other supportive services such as assistance in obtaining entitlements, crisis intervention, case management, supportive and family counseling, substance abuse treatment, and the full range of educational, vocational and other services. The Coming Home Program also employs a Peer Model which provides a positive role model that demonstrates to new clients how people are able to overcome their challenges and be successful.

Monica is a former client of the Coming Home Program and substance abuse treatment. She completed both programs last year and is currently in a stable home which has allowed her to seek employment because she has a permanent address to put on her resume. She was able to accomplish this with ongoing guidance from Case Manager in the Coming Home Program. She is also considering starting her own organization that will serve homeless men and women. Monica’s success could not have been accomplished without stable housing.

By the numbers:

• 142 clients received Supportive Services
• 107 were placed into Permanent Supportive Housing
• 94 clients received Permanent Housing Placements
• 14 were placed in Facility – Based Housing
• 68 received Tenant Based Rental Assistance