Friday, April 4, 2025
4/4/2025
FY 2024 Behavioral Health Service Expansion - Health Center Program Grant Number: H80CS00008. The Municipality of San Juan (MSJ)-Health Care for the Homeless Program (SJHCHP) is a public entity with a Co-applicant Board of Directors and a Health Center Program Award recipient since 1987. The service area is the municipality of San Juan, PR and target population is the homeless population of San Juan, estimated at 1,077 (2023), with gender distribution of 76.4% men, 23.0% women, 0.4% transgender, and 0.2 other; by sheltered status, 735 (68.3%) unsheltered and 342 (31.7%) sheltered; while 50.14% reported were experiencing homelessness for the first time. The main reasons for experiencing homelessness were: 55.9% substance use disorders (SUD), 33.4% family problems, 20.1% mental health problems, 17.4% financial problems, and 15.2% unemployment, among others. A total of 31 individuals (8.4%) reported being HIV positive. Additional vulnerability factors among the unsheltered included 81.4% with alcohol and/or illegal substance consumption and 37.7% with a diagnostic mental health illness; 38.9% reported living in the street, 12.7% in abandoned buildings and 2.4% in a car. A total of 17% of individuals were considered chronic homeless. Access to safe, reliable, and stable housing is a basic necessity and directly affects physical and mental health of individuals. People experiencing homelessness show much higher rates of physical health issues, mental health conditions and substance use disorders (SUD). While people wait for a housing placement, their physical and mental health conditions often worsen and, without additional support, affordable housing alone becomes less likely to be successful and health-promoting. The SJHCHP provides comprehensive primary/preventive and behavioral health services to the homeless population in four clinic delivery sites and a mobile unit. The SJHCHP is part of a multi-level integrated health delivery system of the MSJ that includes access to specialty care and hospital services, and health center program services, through formal contractual agreements, and/or referral arrangements with the MSJ-Department of Health. The SJHCHP served 736 homeless individuals in 2023, all below 200% of federal Poverty Level, 23.6% uninsured, and 74.7% with Medicaid coverage. In 2023, 511 patients received mental health services (a 58.2% increased from 2020), and 483 received SUD services (a 156.7% increase from 2020), demonstrating the dire and ever increasing need for expanding mental health and SUD services for the homeless population. This application requests $500,000 in BHSE federal funding to: (1) increase the number of patients receiving mental health services; (2) increase the number of patients receiving SUD services, and initiating services for treatment with medications for opioid use disorders (MOUS) for at least 10 patients; and (3) improve behavioral health outcomes of individual experiencing homelessness by further expanding MH/SUD services through increased number of clinical providers and support staff, while expanding and supporting a strong workforce. The additional staff include physician/addiction specialists, licensed clinical psychologists, substance abuse counselor, licensed clinical social worker, registered nurse, and enabling services staff (peer navigators, outreachers, and transportation staff), a program coordinator and a quality coordinator/evaluator to support long-term recovery and significant quality improvement of the homeless population through evidence-based interventions (Cognitive Behavioral therapy, Motivational Interviews, MOUD, and Peer Support). The estimated number of patients to be served by 2025 for mental health are 910 and 583 SUD, with at least 10 patients receiving treatment with MOUD.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).