No place like Safeport:

The planning and process of providing residential substance abuse treatment to public housing tenants in Key West, Florida

Safeport treatment services and evaluation projects are funded by the U.S. Center for Substance Abuse Treatment, the Florida Departments of Children & Families and Law Enforcement, the Able Trust of Florida, and the Government of Monroe County.

William N. Elwood, Ph.D. Research and Development DirectorGuidance Clinic of the Middle Keys, Inc.Marathon and Key West, FL

Henry V. Haskins, PHM Executive Director (retired)Key West and Monroe County Housing AuthoritiesKey West, FL

Presented at the 131st annual meeting of the American Public Health Association, 17 November, 2003, San Francisco.

For reprints, visit www.doctorelwood.com

Drug problems in public housing Illegal drug traffic and abuse in public

housing communities are a persistent social problem.

Many housing authorities respond with extensive security initiatives.

Key West Housing Authority (KWHA) founded the Safeport as a drug elimination program.

The Safeport program confronts demand by providing treatment services to foster sober, productive tenants.

Greetings from Safeport! A gated compound of 25

apartments and a treatment-administration building, within a larger public housing complex.

Clients must qualify for public housing if not already tenants.

Clients rent homes from KWHA and finance their own needs.

The treatment provider, Guidance Clinic of the Middle Keys, Inc. (GCMK), concentrates solely on behavioral health services.

Safeport treatment For 10 years,

KWHA provided treatment services.

In 2001, KWHA contracted with GCMK, the area’s largest behavioral health provider to provide treatment services.

Contracts between agencies Lease between KWHA

and GCMK for treatment center.

Partnership plan delineates respective responsibilities.

Both agencies’ employees facilitate recovery, protect client privacy, and ensure safe, sanitary, and drug-free public housing.

The Safeport treatment modelPhase I: Residential 2-4 months Connections to services Group, individual

counseling Remain on-site

Phase II: Day Another 2-4 months Continued counseling Part-time employment Long-term planning Vocational training

Phase III: Outpatient Reduced counseling

hours Finalize housing plans Full-time employment Begin aftercare

participation

Phase IV: Aftercare Group, individual

counseling Live beyond compound

Behavioral health services

Individual and group counseling Psychiatric services: Assessment and Rx

management Childcare cooperative Ancillary service coordination

Funding Multiple streams ensure comprehensive

behavioral health services: U.S. Department of Housing and Urban

Development U.S. Center for Substance Abuse Treatment U.S. Health Resources and Services

Administration Florida Department of Children and Families Florida Department of Law Enforcement Private foundations and trusts Client co-payments as appropriate

Evaluation findings Variables associated with treatment completion include,

Reduced family conflict High school diplomas Close personal relationships.

Sobriety after treatment is associated with meeting special needs during treatment including, Couples counseling Vocational training Life skills.

Public housing-based treatment reduces overhead expenses to permit treatment service periods appropriate to a client’s addiction severity.

Recommendations HUD empowers individual housing authorities to create

programs that helps tenants resolve social problems. Housing Authorities can have successful relationships

with contractors to provide those services. Interagency agreements and combined financial

resources ensure continued service delivery. Client service coordination should include educational

opportunities, particularly GED training and testing, and vocational training as appropriate.

Agreements between agencies should provide explicit instructions to ensure HIPAA and state regulations—as well as clients’ compliance with HUD requirements.

Safeport resources Alexandre, P. K., Roebuck, M. C., French, M. T., & Barry, M. (2003). The cost of

residential addiction treatment in public housing. Journal of Substance Abuse Treatment, 24, 285-290.

Elwood, W. N., with the Safeport Transition Team. (2001, December). Housing partnership plan to serve Safeport clients-tenants in public housing. Key West: Key West Housing Authority and Guidance Clinic of the Middle Keys.

Elwood, W. N., & Greene, K. (2003). Ready (or not) for Safeport: Mental and physical health characteristics associated with completing public housing-based, substance abuse treatment in Key West, Florida. Poster presentation at the American Public Health Association convention, San Francisco.

Elwood, W. N., & Vega, M. (2003). You’d think we sent them to Missouri! Process evaluation results from a condom use intervention with substance abusers in treatment. Manuscript under review.

Elwood, W. N., Shaw, C. S., & Barsell, D. (2002, October). Health problems of homeless drug users presenting for treatment in Key West, FL. Paper presented at the Health Services Research Among Hard to Reach Populations conference, Key Largo, FL.

Elwood, W. N., Greene, K., Haskins, H. V., & Haskins, K. L. (2001). Fostering drug-free, self-sufficient lives: Preliminary results from the Campus South program. Oral presentation at the American Public Health Association convention, Atlanta.

Elwood, W. N., Greene, K., Haskins, H. V., Haskins, K. L., & Barry, M. A. (2001). Safeport: Results from providing drug treatment to people in public housing. Oral presentation at the American Public Health Association convention, Atlanta.