Introduction to CSH's FUSE Initiative

Communities spend billions of dollars on services that bounce vulnerable people between shelters, hospitals, jails, treatment programs, foster care and the streets. CSH's FUSE model works to solve this problem.

FUSE helps communities to break the cycle of homelessness and crisis among individuals with complex behavioral health challenges who are the highest users of emergency rooms, jails, shelters, clinics and other costly crisis service systems -known as super utilizers.

FUSE increases housing stability and reduces multiple crisis service use--which means more effective use of public funds.

What is FUSE?

FUSE is a CSH signature initiative that helps communities identify and engage super utilizers of public systems and place them into supportive housing to break the cycle of repeated use of costly crisis health services, shelters, and the criminal justice system. It provides a double win for communities, allowing public systems to cut costs while improving outcomes for some of their most vulnerable community members. The model represents an opportunity to transform the homeless, health, and criminal justice systems to increase housing stability, reduce emergency health care use and recidivism to jail, and break the cycle of multiple crisis service use, resulting in public cost offsets. As a comprehensive, systems-change approach to tackling the frequent user problem, successful implementation of FUSE requires not only significant local investment - time, energy and resources – but also strong political and civic will.

FUSE is a nationally recognized model that has been implemented in more than 20 communities nationwide. Because the model promotes use of data to target and track tenants based on their use of systems, outcomes findings have consistently shown reduced system use – and costs – that appeal to communities looking to implement an evidence-based solution to the frequent user/high utilizer problem. The FUSE model has been included in the United States Interagency Council on Homelessness’ (USICH) “solutions” database as a “promising practice”- see more here.

What is a frequent user?

The definition of a frequent user varies by community, and is often driven by the community’s own cross system data matching efforts. A data match can help to illuminate precisely the extent of homeless individuals, as shown through an HMIS system, and jail involved individuals, hospital frequent “flyers,” and/or users of other systems. A couple examples we have seen communities use are:

A number of FUSE programs that focus on homeless frequent users of local jails have used a “4 stays in 5 years” criteria for program eligibility. For these programs, the eligibility criteria for the program is at least 4 stays in each system over the past 5 years, with at least one say in each in the most recent year before the data match. Often, a behavioral health condition, substance use disorder, or other disability (typically broadly defined) is added to the criteria.

The goal of many FUSE initiatives is to reduce public costs. While translating jail time and homeless system usage into dollars involves using average daily rates and booking costs, health costs to hospitals, managed care plans, and state Medicaid systems can be accurately calculated with the right data. A couple FUSE programs have used a “top decile” eligibility approach by creating an eligibility list (or tool) based on a person’s presence in the top 10% of a cost distribution once all costs are calculated/estimated across systems.


Supportive housing for frequent users can accomplish many outcomes that are meaningful for a variety of stakeholders. For public system administrators, data driven targeting translates into reduced system use which in turns mean cost offsets. For on-the-ground staff, it could mean a better quality work environment. For housing and service providers, it can speak to an agency mission toward serving the most vulnerable members of communities. Most critically though, supportive housing for frequent users breaks the institutional cycle and improves and stabilizes the lives of the tenants reached by the programs. Here are some high level outcomes:FUSE_ScaleGraphic



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