SHOW ME

RECOVERY

HOUSING

PROGRAM FFY2020 and FFY 2021 Action Plan

Missouri Department of Mental Health

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Contents Program Summary ........................................................................................................................................ 2

Missouri Recovery Housing Needs ................................................................................................................ 2

Definitions ..................................................................................................................................................... 3

Resources ...................................................................................................................................................... 4

St. Louis Recovery Access Site ................................................................................................................... 4

Missouri Department of Economic Development .................................................................................... 4

Missouri Department of Mental Health ................................................................................................... 4

State Opioid Response Grant .................................................................................................................... 5

Missouri Coalition of Recovery Support Providers ................................................................................... 6

St. Louis Continuum of Care...................................................................................................................... 6

Veterans Administration St. Louis Health Care System ............................................................................ 7

Administration Summary .............................................................................................................................. 7

Use of Funds.................................................................................................................................................. 8

Method of Distribution ............................................................................................................................. 8

Eligible Activities ....................................................................................................................................... 8

Activities Carried Out Directly ................................................................................................................... 9

Eligible Subrecipients ................................................................................................................................ 9

Criteria for Evaluation of Applications .......................................................................................................... 9

Anticipated Outcomes and Expenditure Plan ............................................................................................. 10

Expenditures ........................................................................................................................................... 10

Outcomes ................................................................................................................................................ 10

Citizen Participation Summary .................................................................................................................... 10

Partner Coordination .................................................................................................................................. 11

Subrecipient Management and Monitoring ............................................................................................... 17

References .................................................................................................................................................. 12

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Program Summary The Show Me Recovery Housing Program (SMRHP) is a pilot recovery housing program drafted in accordance with Federal Register Notice No. FR-6225-N-01. The Missouri Department of Economic Development (MDED), in partnership with the Missouri Department of Mental Health (MDMH), will administer the FY20 and FY21 pilot program in the amount of $1,700,217.00 (FY 2020 $839,000.00 + FY 2021 $861,217.00). For the project period of December 31, 2021, to September 1, 2028, we anticipate SMRHP will serve 120 households. Of the $1,700,217.00, $251,000 will be expended no later than August 16, 2022, or one year after the execution of the initial United States Department of Housing and Urban Development (HUD) contract. SMRHP will prioritize funding to entities with the greatest need and ability to deliver effective recovery housing assistance in a timely manner.

The purpose of SMRHP is to provide stable, temporary housing to individuals in recovery from a substance use disorder in order to assist them on their path to self-sufficiency. This project will provide supports to assist the individual in recovery to move on to independent living after exiting the project. SMRHP funds will assist individuals in recovery from a substance use disorder for a cumulative period of no more than two years or until the individual secures permanent housing, whichever is first. The project will provide recovery housing and services for individuals in recovery. The leasing units utilized will be multi-family unit(s) with furnished individual apartments to provide housing for individuals in recovery and their families. The housing unit selected will provide at least one common area for group meetings. The project will have dedicated crisis stabilization units, which can house someone in a substance use crisis immediately and for a period of up to 14 days to provide intensive stabilization supports prior to transferring them to the recovery housing project apartment unit. The project will promote a culture of recovery and the following services will be offered: assessment, peer supports, therapy, groups, care coordination, recovery coaching, recovery counseling, medication assisted therapy, trauma informed care, family counseling, education, and other structured therapeutic measures, in addition to a safe place to live with a supported path to permanent housing.

Missouri Recovery Housing Needs According to CDC data, the 2019 age-adjusted drug overdose death rate in Missouri was 26.9 per 100,000 individuals compared to the national average of 21.6 (Centers for Disease Control and Prevention, 2019). According to statewide drug overdose death data from the Missouri Department of Health and Senior Services (MDHSS), the Eastern Missouri Region1 has remained the epicenter of the drug overdose crisis in Missouri, although there are pockets of high 1 MDMH designates these counties as the Eastern Region: St. Louis City, St. Louis, Jefferson, Franklin, St. Charles, Warren, Lincoln, Montgomery, Pike, Audrain, Ralls, Monroe, Marion, Shelby, Macon, Lewis, Knox, Adair, Clark, Scotland, and Schuyler.

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mortality elsewhere, and especially in urban areas. The five hardest hit counties in 2019 and the first three quarters of 2020 were: St. Louis County, St. Louis City, Jackson County, St. Charles County, and Jefferson County. Collectively these counties accounted for 1,746 of 2,967 deaths (59%) (Missouri Department of Health and Senior Services [MO DHSS], 2021).

In 2019, the rate of drug overdose deaths was 143.9 per 100,000 individuals in St. Charles County (101 deaths), 79.8 in St. Louis City (246 deaths), 45.8 in Jefferson County (103 deaths), 33.3 in St. Louis County (332 deaths), and 20.1 in Jackson County (141 deaths) (MO DHSS, 2021). In the first three quarters of 2020, approximately 80 percent of all Missouri drug overdose deaths occurred among African American/Black individuals located in the Eastern Region (MO DHSS, 2021). Furthermore, the rate of opioid overdose deaths among African American/Black individuals in Missouri is the third highest in the United States; deaths in the Eastern Region are responsible for the majority of these deaths (Kaiser Family Foundation, 2019). Therefore, the Eastern Region, and particularly the St. Louis region, is the area that has been identified as the highest need for recovery housing with the limited resources available. Through further examination of drug-involved deaths by zip code within St. Louis, the following were identified as hardest hit zip codes: 63111, 63112, 63113, 63115, and 63118 (St. Louis City Medical Examiner’s Office, 2020).

The population in the St. Louis metropolitan area is approximately 2,807,338. The average rate of drug overdose deaths in St. Louis metropolitan area is 56.6 per 100,000. This would mean around 1,588 overdose deaths in the St. Louis area in one year. Currently, there are 518 accredited recovery housing beds in the St. Louis area. This is less than one-third of the beds needed to provide recovery housing to prevent the number of anticipated overdose deaths.

Due to the disproportionate number of drug overdose deaths observed in the St. Louis region, lack of accredited recovery housing in the region and the disproportionate effect of overdose deaths on Eastern Region African American/Black individuals, data supports prioritizing St. Louis for the SMRHP funding. Based upon the evidence provided, MDMH believes the most effective use for these limited pilot funds would be to concentrate them in the area of greatest need so as to provide the most impactful outcome.

Definitions Recovery: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Individual in recovery: An individual in a process of change through which they will improve their health and wellness, live a self-directed life, and strive to reach their full potential.

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Substance use disorder: recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.

Recovery Support Provider: Missouri Coalition of Recovery Support Providers (MCRSP) accredited recovery agency within the State of Missouri who has a contract to provide recovery support services with MDMH.

Subrecipient: a public or private nonprofit agency, authority, or organization, or a for-profit entity authorized under § 570.201, receiving RHP funds from the recipient or another subrecipient to undertake activities eligible for such assistance under subpart C of this part. The term excludes an entity receiving RHP funds from the recipient under the authority of § 570.204, unless the grantee explicitly designates it as a subrecipient. The term includes a public agency designated by a unit of general local government to receive a loan guarantee under subpart M of this part 200, but does not include contractors providing supplies, equipment, construction, or services subject to the procurement requirements in 2 CFR part 200, subpart D.

Resources St. Louis Recovery Access Site

The St. Louis Recovery Access site is located within Child and Family Empowerment Center, St. Louis, MO, (314) 274-2524. An individual may walk in, call, or have a referral from another service provider to the St. Louis Recovery Access Site. When the individual presents to the site, they are screened and assessed for needs. The individual is offered a choice of services and providers which includes peer coaching, recovery housing, transportation and other services.

Missouri Department of Economic Development

The Missouri Department of Economic Development (MDED) works to create an environment that encourages economic growth by supporting Missouri’s businesses and diverse industries, strengthening our communities, developing a talented and skilled workforce, and maintaining a high quality of life. MDED administers the Community Development Block Grant for Missouri.

Missouri Department of Mental Health

MDMH is the single state authority for substance use disorder and mental health services. Missouri law provides three principal missions for the department: (1) the prevention of mental disorders, developmental disabilities, substance use disorders, and compulsive gambling; (2) the treatment, habilitation, and rehabilitation of Missourians who have those conditions; and (3) the improvement of public understanding and attitudes about mental disorders, developmental disabilities, substance use, and compulsive gambling.

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MDMH serves approximately 170,000 Missourians annually through state-operated facilities and contracts with private organizations and individuals. The seven state-operated psychiatric facilities include inpatient psychiatric care for adults and children, as well as sex offender rehabilitation and treatment services. In addition, five habilitation centers and six regional offices serve individuals with developmental disabilities. Other services are funded through a variety of privately operated programs statewide, including approximately 1,300 contracts managed annually by MDMH.

MDMH funds recovery support programs which offer services such as care coordination, recovery coaching, spiritual counseling, group support, recovery housing and transportation, before, during, after, and in coordination with other substance use disorder service providers. These services are offered in a multitude of settings, including community, faith-based and peer recovery organizations. Recovery support programs are person-centered and self-directed, allowing individual’s choice of provider. Recovery Support general revenue and State Opioid Response dollars may support recovery housing up to six months. After the initial six months, individuals in recovery will make payments toward their recovery housing utilizing a standard means test, adjusted income and/or minimum payments. The following are billable recovery housing and service activities through the MDMH: Recovery Housing is billable at $25.88 per day; Care Coordination at $5.44/15 min; Recovery Coaching at $10.45/15 min; Recovery Counseling at $14.36/15 min; Counseling Intern at $7.32/15 min; Group at $3.24/15 min; Spiritual Counseling at $10.87/15 min; Transportation-Mileage per Mile at $0.52; Transportation-Public per Pass at $1.00/Unit.

A wide array of MDMH-supported clinical treatment and recovery support services are located across the state, including in the St. Louis region. MDMH has developed treatment programs that focus on providing a complete continuum of recovery services, including extended outpatient services in the community and close to home where possible. Individualized service packages are offered to provide Missourians with ready access to treatment and to assist them in achieving and maintaining recovery from substance use. Treatment is individualized and routinely includes assessment, individual and group counseling, family counseling, education, participation in self-help groups, and other structured, therapeutic measures. In addition, families can also participate in individual and group codependency counseling. Detoxification and residential support services are offered for those who need a safe, substance-free environment during the treatment process. These treatment programs are funded through Medicaid, Mental Health Block Grant, Substance Use Block Grant, and other state funding.

State Opioid Response Grant

The Missouri State Opioid Response Project expands access to integrated prevention, treatment, recovery support, and harm reduction services for individuals with opioid use

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disorder (OUD) and stimulant use disorder (StimUD) throughout the state. MDMH is leading the project, with administration, implementation, and evaluation activities provided by the University of Missouri, St. Louis - Missouri Institute of Mental Health (UMSL-MIMH), as well as behavioral healthcare agencies, academic institutions, people with lived addiction, and other content experts from around the state. This project is funded through SAMHSA’s State Targeted Response and State Opioid Response grants. Missouri has received over $66,000,000 to date for those projects.

Missouri Coalition of Recovery Support Providers

The Missouri Coalition of Recovery Support Providers (MOCRSP) is a network of faith-based and community organizations that restore and rebuild lives and families broken by addiction. Their primary mission is to identify, unite, mobilize, and empower grassroots recovery support providers to help people break their cycles of mistakes fueled by mental health challenges and harmful addictions. MOCRSP is the accrediting body for recovery housing as the National Alliance for Recovery Residence Affiliate. MOCRSP established quality standards for recovery residences in Missouri and manages the accreditation process.

St. Louis City Continuum of Care

The St. Louis City Continuum of Care (STL CoC) is a membership organization comprised of more than 100 organizations and individuals from the private and public sector who work in partnership to prevent and end homelessness in the City of St. Louis. The STL CoC engages, aligns, and unites the community to end homelessness and ensure safe and supportive housing for all. STL CoC manages the CoC’s single, comprehensive grant application to HUD for McKinney-Vento funding, which includes Continuum of Care Program funds and State Emergency Solutions Grant (ESG) funds. The STL CoC currently receives approximately $12,438,210 in HUD CoC funding, the vast majority of which is for permanent housing.

St. Louis County Continuum of Care

The St. Louis County Continuum of Care (STL County CoC) is a membership organization comprised of more than 100 organizations and individuals from the private and public sector who work in partnership to prevent and end homelessness in St. Louis County. The STL County CoC is a dedicated alliance of community leaders working to prevent, reduce, and end homelessness for vulnerable families and individuals in the area. Together the group works to effectively implement the programs and policies required to sustain a community-wide crisis response system capable of providing prevention resources, supportive services, and emergency, transitional, and permanent housing options. STL County CoC manages the CoC’s single, comprehensive grant application to HUD for McKinney-Vento funding which includes Continuum of Care Program funds and State Emergency Solutions Grant (ESG) funds. The St.

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Louis County CoC received $2,123,292 in CoC funding in Fiscal Year 2020. The STL County CoC will be able to make referrals to the SMRHP through the St. Louis Recovery Access Site.

Veterans Administration St. Louis Health Care System

The VA St. Louis Health Care System provides inpatient and ambulatory care in medicine, surgery, psychiatry, neurology, and rehabilitation, and many other subspecialty areas. It is a two-division facility that serves veterans and their families in east central Missouri and southwestern Illinois. The John Cochran Division is located in midtown St. Louis and has all of the medical center's operative surgical capabilities, the ambulatory care unit, intensive care units, outpatient psychiatry clinics, and expanded laboratory. It provides psychiatric treatment, spinal cord injury treatment, a nursing home care unit, geriatric health care, rehabilitation services, and a rehabilitation domiciliary program for homeless veterans. These programs and services are funded through the Veterans Administration.

Summary of Resources St. Louis Recovery Access Site Missouri Department of Economic Development Missouri Department of Mental Health State Opioid Response Grant Missouri Coalition of Recovery Support Providers St. Louis City Continuum of Care St. Louis County Continuum of Care Veterans Administration St. Louis Health Care System

Administration Summary MDMH, Missouri’s Single State Agency (SSA), will utilize existing staff to administer the SMRHP. An interagency partnership agreement will be developed to memorialize what is in this action plan. MDED is the CDBG administrator for the state.

Missouri Department of Mental Health Rosie Anderson-Harper, Director of Recovery Services Division of Behavioral Health Rosie.Anderson-Harper@dmh.mo.gov (573) 526-5890 1706 E. Elm Street Jefferson City, MO 65101

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Missouri Department of Economic Development Mary Rajek, Program Manager Community Development Block Grant, Business and Community Solutions Mary.Rajek@ded.mo.gov (573) 751-2395 301 W. High St. Jefferson City, MO 65101

National Objective

All HUD funds are required to meet a National Objective. Per the Federal Register that established the Recovery Housing Program, the Low- to Moderate-Income (LMI) National Objective is the only one that may be utilized under the RHP program. Within the LMI National Objective, all eligible non-administrative activities will comply with the LMI Limited Clientele. This includes several presumptive categories, meaning that HUD assumes individuals within these categories are automatically LMI; these include:

• Abused children • Elderly persons • Battered spouses • Homeless persons • Adults meeting Bureau of Census’ definition of severely disabled adults • Illiterate adults • Persons living with AIDS, and • Migrant farmworkers.

The FR 6225 N-01 also expanded this presumptive list to include persons who meet the federal poverty limits or are insured by Medicaid. If a participant does not qualify under one of these categorical presumptions, the RHP will require documentation that one of the following conditions are met:

1. Require information on family size and income so that it is evident that at least 51 percent of the clientele are persons whose family income does not exceed the LMI limit. Reference: 24 CFR 570.483(b)(2)(ii)(B) and (C)

2. Services be of such nature and in such location that it may reasonably be concluded that the activity’s clientele will primarily be LMI persons. Reference: 24 CFR 570.483(b)(2)(ii)(D)

For activities qualifying under Condition 1 above, the LMI limit shall be 80% of the AMI established by HUD for that place at the time in which assistance was provided. Case files for each assisted person or household must include documentation required under the LMI Limited Clientele, listed at 3.6.4 of Chapter 3 of the State Community Development Block Grant Program Handbook available on the HUD Exchange.

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Use of Funds Method of Distribution

Method of Distribution FY20

Total Allocation: $839,000

Administration: $41,950

Technical Assistance: $25,170

Available for Lease, Rent, and Utilities: $771,880

30% to be expended within one year: $251,700

Method of Distribution FY21

Total Allocation: $861,217

Administration: $43,060

Technical Assistance: $25,836

Available for Lease, Rent and Utilities: $792,321

MDMH will release a request for proposals for eligible activities, evaluate proposals and select eligible sub-recipient(s) with approval from MDED. MDMH will assist the selected sub-recipient(s) in connecting with all available resources listed above to ensure positive outcomes for those served in SMRHP. The connection to the resources will ensure non-duplication of efforts and efficient use of resources by leveraging what is existing against the SMRHP.

Eligible Activities

SMRHP funds may be used to make payments for lease, rent, utilities, and associated typical rental costs (e.g., fees), for the purpose of providing stable, temporary housing, on behalf of an individual or family in recovery from a substance use disorder. Projects which intend to utilize a master lease structure with a property owner will receive preference. An individual may be assisted through SMRHP for up to two years or until the assisted individual secures permanent housing, whichever is earlier. These payments may not be made directly to an individual, but rather to property owners/managers and/or utility companies. These payments may not have been previously paid from other sources; and the payments must result in either a new service and/or a quantifiable increase in the level of an existing service above that which has been provided in the 12 calendar months prior to approval of the RHP Action Plan. SMRHP funds may also be utilized for administration and technical assistance provided to the SMRHP.

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Activities Carried Out Directly

Administration activities will be carried out directly by MDMH.

Eligible Subrecipients

Subrecipient applicants for the SMRHP technical assistance must be an existing 501(c)3 not-for-profit agency with a history of providing training and technical assistance on behalf of MDMH. Applications will be reviewed and scored for their ability to deliver effective assistance and prior performance.

Subrecipient applicants for the SMRHP must be an existing MDMH contracted Recovery Support Services Provider who is Medication Assisted Treatment-capable. The eligible subrecipient must have a formal written agreement with Missouri Department of Mental Health-contracted and certified substance use disorder treatment program(s) to provide clinical treatment services. Applications will be reviewed and scored for their ability to deliver effective assistance, prior performance and other criteria outlined below. To ensure those with the greatest need are screened in to the SMRHP, the project must accept referrals from the St. Louis City CoC coordinated entry system as well as the Recovery Access Site, which are well marketed and known to providers in the community which allows those in the community with the greatest need to be referred to the project. The project applicant must demonstrate timeliness in previous housing expenditures and billing as well as startup of new recovery housing units.

Criteria for Evaluation of Applications Scoring Criteria Maximum Points Project location in identified need zip code 10 Project design provides wrap around services 10 Project design provides safe environment 10 Coordination with local service providers 10 Data collection plan 10 Ability to expend funds within 3 months 10 Ability to serve families with children 5 Staff Qualifications 10 Years of experience 5 Project capacity 10 Plan to assist participants to obtain permanent housing

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Total Score 100

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Anticipated Outcomes and Expenditure Plan Expenditures

MDMH started meeting with key recovery service stakeholders in early 2021 to ensure potential subrecipients are aware of the new RHP funding opportunity presented to Missouri. MDMH will accept and review proposals once MDED receives RHP Action Plan approval from HUD. The funding will be expended quickly in the initial phases of the project for leasing of new recovery housing units. It is understood that $251,700 shall be expended within one year of the executed FY20 contract. Administrative costs will be capped at five percent. The remaining funds will be used to fund RHP activities such as leasing, rent and, utilities.

Outcomes

The application(s) which are funded through the SMRHP will be required to provide data to demonstrate and support their effectiveness in achieving the following outcomes:

Outcome #1: serve at least 120 households in recovery housing. Approximately 20 per year in the SMRHP after the initial leasing of SMRHP units.

Outcome #2: 85 percent of SMRHP beneficiaries will exit to permanent housing. At minimum, 102 households will exit to permanent housing. Program participants will be contacted one year after exiting the SMRHP to determine if they are still residing in permanent housing.

Projected outcomes and expenditures are provided on the following pages.

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Quarterly Projection of Outcomes Quarter Housed Individuals Individuals Transitioned to Permanent

Housing Total Projected Individuals

Quarterly Projection

Total Actual Individuals

Actual Reported Individuals

Total Projected Individuals

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1 10 10 0 0 0 0 2 20 10 0 0 0 0 3 30 10 0 2 2 0 4 40 10 0 5 3 0

5 50 10 0 8 3 0 6 60 10 0 11 3 0 7 70 10 0 14 3 0 8 80 10 0 17 3 0 9 90 10 0 20 3 0 10 100 10 0 23 3 0 11 110 10 0 26 3 0 12 120 10 0 29 3 0 13 130 10 0 32 3 0 14 140 10 0 35 3 0 15 150 10 0 38 3 0 16 160 10 0 41 3 0 17 170 10 0 44 3 0 18 180 10 0 47 3 0 19 190 10 0 50 3 0 20 200 10 0 53 3 0 21 210 10 0 56 3 0 22 220 10 0 59 3 0 23 230 10 0 62 3 0 24 240 10 0 65 3 0 25 250 10 0 68 3 0 26 260 10 0 71 3 0 27 266 6 0 74 3 0 28 269 3 0 77 3 0

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Quarterly Projection of Expenditures Quarter Rent, Utilities, and Lease Admin and TA

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1 $47,000 $47,000 $0 $22,621 $22,621 $0 2 $94,000 $47,000 $0 $31,242 $8,621 $0 3 $141,000 $47,000 $0 $39,863 $8,621 $0 4 $188,000 $47,000 $0 $48,484 $8,621 $0

5 $235,000 $47,000 $0 $50,179 $1,695 $0 6 $282,000 $47,000 $0 $51,874 $1,695 $0 7 $329,000 $47,000 $0 $53,569 $1,695 $0 8 $376,000 $47,000 $0 $55,264 $1,695 $0 9 $423,000 $47,000 $0 $56,959 $1,695 $0 10 $470,000 $47,000 $0 $58,654 $1,695 $0 11 $517,000 $47,000 $0 $60,349 $1,695 $0 12 $564,000 $47,000 $0 $62,044 $1,695 $0 13 $611,000 $47,000 $0 $63,739 $1,695 $0 14 $658,000 $47,000 $0 $65,434 $1,695 $0 15 $705,000 $47,000 $0 $67,129 $1,695 $0 16 $752,000 $47,000 $0 $68,824 $1,695 $0 17 $771,880 $19,880 $0 $68,824 $0 18 $771,880 $0 $68,824 $0 19 $771,880 $0 $68,824 $0 20 $771,880 $0 $68,824 $0 21 $771,880 $0 $68,824 $0 22 $771,880 $0 $68,824 $0 23 $771,880 $0 $68,824 $0 24 $771,880 $0 $68,824 $0 25 $771,880 $0 $68,824 $0 26 $771,880 $0 $68,824 $0 27 $771,880 $0 $68,824 $0 28 $771,880 $0 $68,824 $0

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Citizen Participation Summary The State of Missouri’s HUD-approved Citizen Participation Plan encourages citizens to participate in the development of housing and community development needs across the state, and will be utilized to determine public input guidelines for the Recovery Housing Program Action Plan. The Citizen Participation Plan was developed in accordance with the requirements listed in 24 CFR Part 91.115 (Citizen Participation Plan for States). The Plan provides citizens (including minorities, disabled, and non-English speaking persons), units of local government and other interested parties a reasonable opportunity to comment on the action plan and encourages them to do so. Under “Signed Waiver of CPD citizen participation requirements re virtual hearings FINAL_012521” effective through August 16, 2021, all Public Meetings for this Action Plan will be held in an online format. Outreach activities conducted to date include meetings with Missouri Coalition of Recovery Support Providers Administration, the entity within the state of Missouri which accredits recovery housing, meetings with current recovery support service providers, other substance use treatment professionals, and Missouri Institute of Mental Health.

Partner Coordination The HUD Recovery Housing Program direct grantee, Missouri Department of Economic Development, has partnered with the State Opioid Response and Substance Abuse Block Grant grantee, Missouri Department of Mental Health, to create this Action Plan in collaboration with the Missouri Housing Development Commission. These partnerships will continue throughout the life of the SMRHP. The Missouri Coalition of Recovery Support Providers have been actively involved in providing input to the development of the SMRHP.

The SMRHP will make referrals through the STL CoC to connect participants with resources such as permanent housing. The recovery housing project will make referrals through the coordinated entry access point, St. Patrick Center, to access those CoC resources. SMRHP will make referrals to John Cochran Veterans Hospital for Veterans Administration Supportive Housing (VASH) program and St. Patrick Center for Supportive Services for Veteran Families (SSVF) for veterans in recovery. SMRHP will provide referrals to Veterans Administration employment services, Employment Connection, and other employment resources to ensure participants are able to exit the SMRHP to a stable, permanent housing situation.

SMRHP-funded agencies are encouraged to coordinate with other federal substance use-related assisted partners, such as State Opioid Response grantees and Substance Abuse Block Grant grantees from Missouri Department of Health and Human Services, as well as other partners potentially serving the same populations, such as HUD’s Continuum of Care Program, Emergency Solutions Grant program, HOPWA program, and HUD-VASH. SMRHP grantees are also encouraged to consult with a range of residential recovery service providers, such as

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private, faith-based nonprofits, public nonprofits such as Public Housing Authorities, or other entities assisting individuals in recovery.

Subrecipient Management and Monitoring SMRHP monitoring will occur on an ongoing basis. Monitoring will be conducted in a manner that assists sub recipient(s) in meeting their goals and working through challenges while maintaining compliance with regulations and state guidance governing the SMRHP. Feedback from sub recipient(s) will be requested regularly as well as any type of technical assistance they would find advantageous to furthering the outcomes of the SMRHP. SMRHP-funded agencies will be monitored at least annually. A monitoring tool will address all eligible activities carried out by the sub recipient(s). The monitoring tool will be provided to sub recipient(s) prior to implementation of eligible activities for SMRHP.

References 1. Centers for Disease Control and Prevention. (2019). 2019 Drug Overdose Death Rates.

Accessed at: https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2019.html

2. Henry J. Kaiser Family Foundation. (2019). Opioid Overdose Deaths by Race/Ethnicity. Accessed at: https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

3. Missouri Department of Health and Senior Services (2021). Quarterly Data Request DHSS 2020 - Quarters 123_v2.0 [Data file]. Union, MO.

4. St. Louis City Medical Examiner’s Office (2020). All-drug-related fatalities 2011-2020 [Data file]. St. Louis, MO.

5. St. Louis County Medical Examiner’s Office (2020). All-drug-related fatalities 2011-2020 [Data file]. St. Louis, MO.