Integrated Care Case Study
Downtown Emergency Service Center (DESC)
Seattle, Washington
The Downtown Emergency Service Center (DESC) is a multi-service center serving disabled and vulnerable homeless adults; it is one of the largest such centers in the Northwest. It serves over 5,000 people annually, providing emergency shelter and survival services, clinical programs and supportive housing. DESC has been recognized by HUD and others both for the quality of care it provides and for the effective integration of its services. The care provided by DESC is both comprehensive and seamless, offering clients a full “continuum of care” within the agency.
To achieve its goal of providing comprehensive and integrated care, DESC has formed partnerships with the business community, corrections, law enforcement, political organizations, and the County.
PROGRAMS
1. Emergency Services and Overnight Shelter Program: The Emergency Shelter Program serves more than 4,000 men and women each year. It provides safe, secure shelter, hot meals, and a day-time safe haven from the streets It is also central to DESC’s outreach efforts as it helps people access a wide range of programs (both at DESC and elsewhere) to help them stabilize their lives, and ultimately get permanent housing. Services available at DESC include hygiene facilities, mail and phone services, information and referral, emergency clothing, and on-site medical care, mental health counseling and chemical dependency treatment. A bi-weekly dermatology clinic is also available.
2. Clinical Programs: DESC provides mental health and chemical dependency treatment services to address the needs of mentally ill homeless people, the majority of DESC’s clients. It provides services through a continuum of care that includes street outreach and engagement, case management, and short- and long-term care. These services are delivered through the following four components:
§ Homeless Outreach Stabilization and Transition (HOST): HOST case managers conduct outreach and provide intensive case management on the streets, in shelters, hospitals, jails, libraries, and other facilities, seeking out people who are mentally ill and homeless. DESC’s drop-in center allows people to proceed at their own pace and become familiar with the environment. When they are ready, case managers help identify their underlying issues and service needs, facilitate access to services (whether at DESC or with other service providers), help achieve clinical and social stabilization, secure housing, and transition into long-term case management.
§ Support, Advocacy and Growth Enhancement (SAGE): SAGE is the ongoing comprehensive case management component of DESC's mental health program. SAGE case managers work with clients to help them obtain and maintain housing, improve clinical and social stability, and enrich and enhance their level of independence and self-sufficiency.
§ Chemical Dependency Treatment: Chemical dependency clients usually have a sustained and/or complicated substance abuse history, while many also suffer from a co-occurring mental disorder. DESC provides integrated mental health and substance abuse treatment – substance abuse counselors work in coordination with mental health case managers in both the emergency shelter and in supportive housing projects, so that services meet clients at their current level and offer support for change.
§ Crisis Respite Program (CRP): The Crisis Respite Program (CRP) provides shelter and case management for severely mentally ill homeless adults emerging from a recent crisis or jail. CPR helps them to stabilize in safe, secure and supportive surroundings and to connect with ongoing services and housing.
3. Supportive Housing Program: DESC follows a Housing First model and operates under the belief that clinical stabilization of mentally ill, addicted, and homeless people will occur more quickly if housing is provided first. To this end, DESC has developed a variety of supportive housing options, all of which include case management and/or on-site coordination of support services to facilitate long-term tenancy. DESC´s supportive housing consists of the following programs:
§ The Union Hotel - At The Union, 52 formerly homeless, disabled tenants live in their own apartments. The building is staffed 24-hours a day, and an on-site Service Coordinator maintains close contact with tenants and coordinates their access to supportive services.
§ The Lyon Building - The Lyon Building has 64 units of permanent housing for homeless adults with multiple disabilities, including HIV/AIDS, mental illness and chemical dependence. Project staff, including four clinical specialists, provide intensive support and coordination to ensure that residents' service needs are met and housing is successfully maintained.
§ Kerner-Scott House – This is the site of a DESC shelter for mentally-ill women, and it contains 40 units of housing. Twenty- five units provide "Safe Haven" housing for homeless mentally ill people who are not currently receiving services. The units themselves serve as tools to help engage clients into receiving services. The residential setting helps facilitate clients' movement toward permanent housing and increased self-sufficiency. The 15 units located on the top floor are occupied by chemically dependent formerly homeless adults in recovery.
§ The Morrison is DESC’s largest housing project, containing 190 units of permanent housing for formerly homeless adults with serious disabilities.
§ 1811 Eastlake – This facility provides supportive housing to 75 men and women with chronic alcohol addiction. Residents benefit from 24 hour - 7 day a week support including mental health and chemical dependency treatment, primary health care, meals and counseling assistance. The project aims to improve the lives of its residents through reduced alcohol consumption, better health care, and increased stability.
§ Scattered Site Housing – DESC also has housing subsidies which case managers use to place their clients into rental properties throughout Seattle. Using HUD Supportive Housing Program leasing funds, DESC leases units directly from private property owners and in turn subleases to its residents at 30% of their income. Case management services are integrated with the housing to provide the necessary support for people to succeed and stabilize.
In addition to these programs, DESC operates a thrift store to provide vocational opportunities for clients, and is in the process of developing a more comprehensive vocational program.
Additional Information: www.desc.org