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NYC FUSE - EVALUATION FINDINGS

Approximately 12 million incarcerated people are released from local jails each year in the United States.  Poverty, homelessness, chronic addiction, persistent mental illness, and health problems are widespread among the jail population.  Given that 80% of inmates are incarcerated for less than one month, jails have little ability to address these deep-seated personal and community challenges.  Research shows that supportive housing helps to end homelessness for persons with complex needs and to reduce overall public systems’ involvement and costs.

The Frequent User Services Enhancement (FUSE) initiative is a supportive housing program developed by CSH with support from various government agencies that provided housing and support services to individuals who were frequently cycling in and out of jails, homeless shelters, and hospital emergency rooms in 2008.  A two-year follow up evaluation found that FUSE participants spent significantly fewer days in jails and shelters and engaged in less cycling between public systems. These service use reductions resulted in significant cost savings to the government and tax payers.

CSH's Role

The FUSE II evaluation was extremely rigorous in methodology.  A major feature was the inclusion of a comparison group that was selected from the same shelters as the participants in the FUSE program with most of the same characteristics that pertained to FUSE eligibility.   In addition, propensity score analysis was done to further match the comparison group to the intervention group.    This produced an unusually well-matched comparison group.

An innovative analysis strategy was the use of Trajectory Analysis.   By examining the patterns of shelter, jail and hospital use, typical pathways through the system were identified.   These different trajectories allow for a clearer picture of how the study participants use these systems and how interventions could be most strategically developed.

Impact and Outcomes

FUSE Participants Stayed Housed

Percent FUSE Participants Housed in FUSE-Provided Housing
At and Over 12 and 24 months of Follow-Up Period

                                              Retention in FUSE-provided housing

%

N

Housed in FUSE housing at 12 months

90% 69a

Housed in FUSE housing at 24 months

81% 68b

Housed continuously in FUSE Housing over 24 months

47% 68b

FUSE housing continuously or with brief interruption over 24 months

81% 68b

a Three participants died over first 12 months of follow-up
b Four participants died over 24 months of follow-up

 

Intervention Effects for Housing

Measures

Intervention Group

Comparison Group

Difference of Means

%

N

%

N

Permanent housing at 12 months

91%

57

28%

53

63% ***

Permanent housing at 24 months

86%

55

42%

45

43% ***


Shelter Use Declined Dramatically

Intervention Effects for Homeless Shelter Use
Homeless Shelter Use: From Housing Placement

Measures

Intervention Group Mean

Comparison Group Mean

Difference of Means

Number of days over 24 month follow-up

15

162

-147 ***

Number of episodes over 24 month follow-up

1

9

-8 ***

Any episodes over 24 month follow-up

12%

81%

-70% ***

Number of days over last 3 months of follow-up

2

25

-23 ***

Number of episodes over last 3 months of follow-up

0.1

1

-1 ***

Any episodes over last 3 months of follow-up

3%

33%

-30% ***

 

FUSE participants experienced many positive personal changes including reduced hard drug use and improved levels of social support.

 Intervention Effects on Substance Use, Mental Health,
Physical Health, and Family and Social Support

Measures

Intervention Group Mean

Comparison Group Mean

Difference of Means

Any recent hard drug use

18%

34%

-17% ***

Recent drug use disorder

4%

10%

-7% ***

Recent alcohol abuse

5%

8%

-3% ***

Any current psychiatric diagnosis

50%

50%

-1% ***

Recent episode major depression

13%

8%

5% ***

Recent episode other depression

23%

16%

7% ***

Recent episode anxiety disorder

11%

4%

7% ***

Psychological Stress Scale

7

8

-1 ***

Mental health functioning (MCS)

50

48

2 ***

Physical health functioning (PCS)

44

50

-7 ***

Current family and other social support

29

22

7 *** 


Cost Analysis

The cost component of the evaluation utilized standard methods of cost analysis and found that there is a strong return on investment for this program.

  • For FUSE participants, the average total costs for inpatient and crisis medical and behavioral health services reduced by $7, 308.
  • Over a 12 month period, the intervention reduced average total costs for jail and shelter use by about $8,372 per person.
  • Jail and shelter costs were reduced by 76% for FUSE participants before and after the program (a reduction of $29,208).
  • Through reduced usage of jails, health services and shelters, each individual housed through FUSE generated $15,000 in public savings, paying for over two thirds of the intervention cost.

Partners

Government: New York City Department of Corrections, Department of Homeless Services, Department of Health and Mental Hygiene, Department of Housing and Preservation Development, NYC Housing Authority, Human Resources Administration

Housing and Service Providers:  Brooklyn Community Housing and Services, CAMBA, Common Ground, Community Access, Jericho Project, Palladia, Pathways to Housing

Evaluation Funders: Robert Wood Johnson Foundation, The Jacob and Valeria Langeloth Foundation, Open Society Foundation, The JEHT Foundation

 

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