Resolution 2019-31090 RESOLUTION NO.; 2019-31090
RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF
MIAMI BEACH, FLORIDA, APPROVING AND AUTHORIZING THE CITY
MANAGER TO EXECUTE A MEMORANDUM OF UNDERSTANDING (MOU)
WITH MIAMI BEACH COMMUNITY HEALTH CENTER, ESTABLISHING THE
CITY'S PARTICIPATION IN A PILOT PROGRAM WITH THE HEALTH
CENTER'S VIVITROL PROJECT, FOR A TERM OF THREE (3) YEARS,
SUBJECT TO TERMINATION BY EITHER PARTY UPON PROVIDING THIRTY
(30) DAYS NOTICE; SAID PROGRAM PROVIDING TREATMENT AND A
SUPPORT SYSTEM FOR HOMELESS PERSONS WITH ADDICTION ISSUES
AT NO COST TO THE CITY.
WHEREAS, the National Coalition for the Homeless emphasizes that "substance abuse
can be both the cause and the result of homelessness, and that many people begin abusing
alcohol or drugs after losing their homes"; and
WHEREAS, the Substance Abuse and Mental Health Services Administration
(SAMSHA) reports that nearly 35% of homeless Americans were affected by substance abuse;
and
WHEREAS, the National Coalition for the Homeless has found that 38% of homeless
people are alcohol dependent, and 26% are dependent on other harmful chemicals; and
WHEREAS, overcoming addiction requires intensive treatment and follow-up care as
well as a support system; and
WHEREAS, many homeless people lack a family support system, have no health
insurance or the ability to pay for treatment, and cannot readily access needed services; and
WHEREAS, the most common treatment options available for substance abuse are:
• Inpatient residential treatment
• Outpatient treatment
• Group therapy
• Private/individual therapy; and
WHEREAS, these forms of treatment differ in terms of cost, time commitment, and
availability/accessibility; and
WHEREAS, while these options can be effective, their associated costs and locations
may present significant challenges for most people and may even be perceived as
insurmountable for the homeless; and
WHEREAS, the City and Miami Beach Community Health Center (MBCHC) staff
explored the challenges connecting clients to treatment and focused on medical approaches to
tackle the problem, including the use of pharmaceutical options that block the effects of opioid
and alcohol use; and
WHEREAS, there are currently several medications in the marketplace that are
designed to prevent relapse to opioid dependence after detoxification and to treat alcohol
dependence and these medications should be used in conjunction with drug or alcohol recovery
programs, such as counseling; and
WHEREAS, as with all prescription medications, these medications are intended for
persons who receive screening for appropriateness by a medical practitioner (as they may not
work for everyone); and
WHEREAS, the City and MBCHC have agreed to pursue a pilot program (Program) at
no expense to the City, based upon the following essential terms:
(i) The City will refer homeless clients who express an interest in addiction services
to Miami Beach Community Health Center for a health screening;
(ii) If the client is deemed a good candidate for the approach, MBCHC will provide
the medication and follow-up care at Miami Rescue Mission and its multiple clinic locations in
Miami Beach and North Miami; and
(iii) the City will continue to provide care coordination and additional supports
including: ID replacement, housing referrals, security deposit for independent housing (when the
client is stabilized and as funds allow), and ongoing shelter services during the duration of
stabilizing treatment; and
WHEREAS, this approach provides accessible treatment when the client is ready to
accept services and establishes the supports and wraparound services to ensure that the client
hits the ground running as he pursues employment and community reintegration, and thereafter
provides continued support while the client is employed and/or housed, as services are not
contingent upon the client's homeless status; and
WHEREAS, during this pilot phase of the Program, only men will be served, and if the
pilot is deemed effective, the City and MBCHC will explore expanding service locations and
client reach to include women; and
WHEREAS, as with all services provided by MBCHC, the Agency for Health Care
Administration (AHCA) must provide approval for service expansion and MBCHC has received
this approval for the Program and will be reporting back to AHCA as the Program progresses;
and
WHEREAS, the City and MBCHC believe that this model may offer a replicable solution
for other communities throughout the United States; and
WHEREAS, by entering into a three (3) year Memorandum of Understanding with Miami
Beach Community Health Center for this Program, the City can better serve homeless clients
who report addiction as an impediment to housing and employment success.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION
OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission hereby
approve and authorize the City Manager to execute a Memorandum of Understanding (MOU)
with Miami Beach Community Health Center, establishing the City's participation in a pilot
program with the health center's Vivitrol Project, for a term of three (3) years, subject to
termination by either party upon providing thirty (30) days notice; said Program providing
treatment and a support system for homeless persons with addiction issues at no cost to the
City.
PASSED AND ADOPTED this 11th day of December, 2019.
ATTEST:
Dan Gelbe' ! or
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Rafael E. Granado, City Clerk
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MIAMI BEACH
COMMISSION MEMORANDUM
TO: Honorable Mayor and Members of the City Commission
FROM: Jimmy L. Morales, City Manager
DATE: December 11, 2019
SUBJECT:A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY
OF MIAMI BEACH, FLORIDA, APPROVING AND AUTHORIZING THE CITY
MANAGER TO EXECUTE A MEMORANDUM OF UNDERSTANDING (MOU)
WITH MIAMI BEACH COMMUNITY HEALTH CENTER, ESTABLISHING
THE CITY'S PARTICIPATION IN A PILOT PROGRAM WITH THE HEALTH
CENTER'S VIVITROL PROJECT, FOR A TERM OF THREE (3) YEARS,
SUBJECT TO TERMINATION BY EITHER PARTY UPON PROVIDING
THIRTY (30) DAYS NOTICE; SAID PROGRAM PROVIDING TREATMENT
AND A SUPPORT SYSTEM FOR HOMELESS PERSONS WITH
ADDICTION ISSUES AT NO COST TO THE CITY.
RECOMMENDATION
The Administration recommends approving the Resolution.
BACKGROUND/HISTORY
The National Coalition for the Homeless emphasizes that "substance abuse can be both the cause
and the result of homelessness, and that many people begin abusing alcohol or drugs after losing
their homes." The Substance Abuse and Mental Health Services Administration (SAMSHA) reports
that nearly 35 percent of homeless Americans were affected by substance abuse. According to the
Journal of American Medical Association, substance abuse is more prevalent among the homeless
in America than the general population. A study published in the JAMA Internal Medicine "indicates
that drug overdose is becoming the most common cause of death among homeless people,
surpassing HIV/AIDS." The National Coalition for the Homeless has found that 38% of homeless
people are alcohol dependent, and 26% are dependent on other harmful chemicals.
According to health practitioners, alcohol abuse further exposes people to a variety of additional
health problems, including:
? Liver disease
? Dementia
? Seizure disorders
? Gastrointestinal problems
? Certain types of cancer
? Pancreatitis
? Diabetes
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In 2016, about 21 million people age 12 and older were in need substance abuse treatment,
according to the American Addiction Centers. Of these, only 3.8 million (or 18%) received treatment
for their addiction.
Overcoming addiction requires intensive treatment and follow-up care as well as supports. Many
homeless people lack a family support system, have no health insurance or the ability to pay for
treatment, and cannot readily access needed services. These obstacles can oftentimes seem
insurmountable for people living in poverty or homelessness.
ANALYSIS
Alcohol is widely available and relatively inexpensive, making it one of the most commonly abused
substances within the homeless population, notes the National Coalition for the Homeless. The
National Healthcare for the Homeless Council estimates that up to half of single homeless adults
have abused alcohol, while up to a third abuse other drugs.
The most common treatment options available for substance abuse are:
? Inpatient residential treatment
? Outpatient treatment
? Group therapy
? Private/individual therapy
These forms of treatment differ in terms of cost, time commitment, and availability/accessibility. While
these options can be effective, their associated costs and locations may present significant
challenges for most people and may even be perceived as insurmountable for the homeless. For
example, the homeless needing treatment often lack insurance which can cover the high cost of
treatment. Without insurance, the out-of-pocket costs can make treatment untenable including even
the lower-cost options such as outpatient and individual therapy.
The Office of Housing and Community Services had been exploring alternatives to traditional
addiction treatment as it continued to encounter difficulties in connecting its homeless clients to
conventional treattment. Miami Beach Community Health Center (MBCHC), a federally qualified
health care center serving our city, often sees the same population through its multiple community
clinics. The city and MBCHC staff explored the challenges connecting clients to treatment and
focused on medical approaches to tackle the problem including the use of pharmaceutical options
that block the effects of opioid and alcohol use.
There are currently several medications in the marketplace that are designed to prevent relapse to
opioid dependence after detoxification and to treat alcohol dependence. These medications should
be used in conjunction with drug or alcohol recovery programs such as counseling. As with all
prescription medications, these medications are intended for persons who receive screening for
appropriateness by a medical practitioner(as they may not work for everyone).
As proposed, the city will refer homeless clients who express an interest in addiction services to
Miami Beach Community Health Center for a health screening. If the client is deemed a good
candidate for the approach, MBCHC will provide the medication and follow-up care at Miami Rescue
Mission and its multiple clinic locations in Miami Beach and North Miami. The city will continue to
provide care coordination and additional supports including: ID replacement, housing referrals,
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security deposit for independent housing (when the client is stabilized and as funds allow), and
ongoing shelter services during the duration of stabilizing treatment.
This approach provides accessible treatment when the client is ready to accept services and
establishes the supports and wraparound services to ensure that the client hits the ground running as
he pursues employment and community reintegration. Importantly, the service connection with
MBCHC can continue when the client obtains housing as services are not contingent on the client's
homeless status and can continue after the client has obtained stabilized employment and housing.
During this pilot phase of the program, only men will be served. If the pilot is deemed effective, the
city and MBCHC will explore expanding service locations and client reach to include women. As with
all services provided by MBCHC, the Agency for Health Care Administration (AHCA) must provide
approval for service expansion. MBCHC has received this approval for the pilot program and will be
reporting back to AHCA as the program evolves as this model may offer a replicable solution for other
communities throughout the United States.
The pilot will last for about one year to enable assessment. Medication and services costs (which
vary by patient) will be covered by MBCHC for those pateints without insurance. For those with
insurance, eligible costs will be charged to the insurance companies as appropriate by MBCHC.As a
reminder, MBCHC is a federally qualified health care center providing sliding scale and no cost
health services. Program success will be measured by the number of clients who complete their
treatment plans, obtain employment (or disability benefits) and transition to permanent housing. Staff
will also be tracking those who continue treatment but transition to alternate housing while
participating in the program. Hopefully, the program will offer relief to those facing addiction but who
cannot access traditional treatment programs such as in-patient rehabilitation.
FINANCIAL INFORMATION
No financial impact to city.
CONCLUSION
The city will enter into a Memorandum Of Understanding with Miami Beach Community Health
Center to better serve those male homeless clients who report addiction as an impediment to housing
and employment success. The city will provide client referrals and emergency shelter services and
MBCHC will provide medical treatment and supports. While this is a pilot program, if successful,
efforts will be made to grow the program to serve women, too.
Applicable Area
Not Applicable
Is this a Resident Right to Does this item utilize G.O.
Know item? Bond Funds?
No No
Strategic Connection
Mobility-Address homelessness.
Legislative Tracking
Housing and Community Services
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ATTACHMENTS:
Description
❑ Resolution
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