CSH produced this publication to make the feasibility stage of planning a Pay for Success initiative a little easier. Part of “getting to yes” for data sharing is to know what to ask for – this publication is a tool to help begin those conversations and includes common data elements across a range of public systems that are key to the outcomes-focused project lifecycle. The information presented here will help translate across systems what data may be captured and useful for the purposes of planning an outcomes-focused supportive housing intervention. The Appendix of this report offers some real world examples from four sites that have executed data matches during the planning phase of their supportive housing projects.
This report summarizes conclusions and next steps resulting from the Technical Assistance provided by CSH to the Volunteers of America Delaware Valley. CSH believes the local partnership has the opportunity to successfully finish designing, structuring and implementing a Pay for Success supportive housing project if there is commitment from an entity at the county or state level to making success payments for outcomes achieved. We have documented a number of options for finalizing a target population, outcomes of interest, success metric payment terms and evaluation in the event that an end payer is identified.
This report provides interested stakeholders with a preliminary overview of the outcome
and process evaluations for the HEART (Housing, Empowerment, Achievement,
Recovery and Triumph) Alliance for Sustainable Families. HEART is one of five
national demonstration sites funded by the Children’s Bureau of the Administration of
Children and Families with the United States Department of Health and Human
Services. HEART is a five year demonstration project from October 1, 2012 through
September 30, 2017. This report covers two years of HEART research study data.
HEART is a collaborative community-based supportive housing initiative designed to
assist 50 high risk and high need families in Broward County, Florida achieve family
strengthening as well as housing and economic stability. HEART represents an alliance
of 15 child welfare, housing, legal, health, and social service organizations collectively
working to improve child protection as well as family permanency and well-being.
HEART provides clinical case management, subsidized housing, economic selfsufficiency,
life coaching, legal counsel, health/behavioral health support, and domestic
violence prevention. HEART employs evidence-based interventions such as
Strengthening Families, Trauma-focused Cognitive Behavioral Therapy, and the Center
for Working Families.
Using a Housing First model, HEART seeks to stabilize families involved with the child
welfare system who are at risk of/or experiencing homelessness. To gauge this impact,
Kids In Distress, Inc. (KID) subcontracted with Barry University researchers to conduct
the five-year evaluation of HEART.
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 by Columbia University Mailman School of Public Policy 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. Download our two-page snapshot for the report highlights
Description
The Ending Community Homelessness Coalition (ECHO), Social Finance, and The Corporation for Supportive Housing (CSH), are soliciting Requests for Qualifications from qualified persons/firms with demonstrated capacity and experience to develop and implement a rigorous evaluation of a Pay for Success (PFS) initiative that will provide supportive housing to chronically homeless individuals who are frequent users of both the health and criminal justice systems and struggle with mental health and substance use challenges.
Target Population
The initiative will target chronically homeless high utilizers of public crisis services. This RFQ will be used to identify evaluation persons/firms to conduct a rigorous evaluation to assess the impact and cost-effectiveness of the PFS initiative.
High utilizers are those individuals who are frequently before the court, in jail, and habitually using a spectrum of resources including:
Healthcare — emergency rooms, emergency medical services (EMS), and psychiatric inpatient hospitalizations.
Criminal justice — arrests, jail admissions and bookings.
Evaluation Goals/Scope of Services
ECHO, Social Finance, and CSH are requesting expressions of interest from qualified respondents and have identified three primary goals for the evaluation:
Develop and implement a rigorous experimental or quasi-experimental evaluation design to measure the impact of the programmatic intervention on participant outcomes.
Respondents proposing an experimental evaluation design (e.g. RCT) are encouraged to also briefly describe how you would approach evaluating the PFS project using a quasi-experimental research design, as the review committee desires to consider multiple methodologies to answer the core research questions outlined in this RFQ.
Assist with building a PFS agreement; in particular assist in the development and refinement of success benchmarks and key outcome metrics that will be used to determine performance-based payments; and work with relevant parties to develop data tracking/collection systems and strategies to accurately measure and validate outcomes.
Application Process All proposal items must be submitted ELECTRONICALLY by 5 pm CST on June 4, 2018 to: austinrfq@csh.org . Note: hard copies of proposal or application materials will not be accepted.
Proposal narrative must be submitted in Microsoft Word or PDF format and should not exceed twenty (20) single-spaced pages using Times New Roman 12-point font and one-inch margins.
Increased pressure on public sector budgets has prompted government to focus on improving value for money in social service contracts. In response, Pay for Success (PFS) has been trialed across a range of sectors, from supportive housing to juvenile recidivism, to improve the measurement and delivery of quality outcomes. Since 2015, Value Based Payment (VBP) models have emerged in the healthcare field as a shift away from paying for volume of services. These two innovative contracting models both aim to improve public sector value, and Medicaid entities can use both to more effectively manage population health.
However, the models differ in their approaches and development. PFS focuses on improved service quality and government accountability for expenditure through outcomes-based repayment. By contrast, VBP shifts cost fluctuations to providers, while standardizing quality through performance thresholds. PFS models are more likely to be developed through a feasibility process that involves services providers and their data, whereas co-development is not necessarily a fundamental part of the VBP model. PFS also offers flexible funding to providers for infrastructure and other improvements, whereas this level of flexibility is not available in VBP models until the most sophisticated manifestations, such as population-based payment.
“VBP healthcare payors should ensure that quality is measured in all VBP contracts so that shared savings or shared risk incentives do not endanger patients, particularly for vulnerable, high cost populations.”
Guest Blog by Lorraine Coleman, Vice President of Social Services at Acacia Network and Secretary of the CSH Metro Team’s New York Advisory Board.
Lorraine Coleman
Supportive Housing empowers individuals and families to grow and thrive in the community while challenging the higher health risks associated with poverty. Before their tenancy in supportive housing, residents likely experienced unhealthy living environments, poor education and schools, low wage-earning opportunities with limited mobility, and inferior medical and behavioral health care.
Their lives were transformed by supportive housing but now like the rest of America, they are graying and that presents new challenges for all of us.
By 2050 there will be 83.7 million people over the age of 65; with 1 in 5 being Hispanic. For New York residents, it is imperative that affordable and supportive housing options are available to everyone who needs them. Just as important, we must ensure the appropriate community-based services are in place for every member of our aging society.
Financial barriers and acculturation have negatively impacted traditional elder care in the Hispanic community. In part due to their close familial ties, Hispanic elderly live longer than their non-Hispanic counterparts. But there are larger numbers experiencing poor health and services. The Hispanic elderly face:
64% higher diabetes and obesity rates
Alzheimer’s symptoms that are exhibited 7 years earlier
Higher reliance on Medicaid and Social Security
Inadequate care coverage; 30% lack health insurance
Scarcity of culturally and linguistically sensitive providers
Through supportive housing, community-based social services providers care for seniors while ensuring caregivers have peace of mind. For Acacia Network, a not-for-profit Latino-led integrated care organization, this was a challenge that resonated with our mission to partner in our communities, lead change, and promote healthy and prosperous individuals and families in a healthy environment.
Through the MRT Senior Supportive Housing Pilot funded by the New York State Department of Health (DOH), Acacia was able to identify a primarily monolingual, aging Hispanic community within supportive housing struggling with histories of poor health and healthcare access. Introduction of culturally and linguistically competent services and perseverance lead to the acceptance of supports that assist tenants with aging successfully in place.
With CSH’s partnership, Acacia was linked to private resources to further enhance our capabilities. CSH has been an advocate and an educator for serving the elderly who are aging in place in supportive housing. They leverage the knowledge of the community-based provider with data and statistics, and work to push policy changes and develop new resources for social service staff and agencies interested in serving the aging population.
The DOH Pilot had a significant impact on the lives of the seniors we help. With the funding available and assistance from CSH, we can expand the scope and breadth of our services and ensure more Hispanics aging in supportive housing are receiving the care they deserve.
Access the full whitepaper Promoting Healthy Aging in Supportive Housing: A Review of the MRT Senior Supportive Housing Pilot by clicking here.
A special “Thank You” to the Mizuho Foundation and The Fan Fox and Leslie R. Samuels Foundation, Inc. for making the whitepaper possible.
Spurred by investments from the Corporation for National and Community Service, CSH has been leading a five-year national demonstration to create and evaluate supportive housing for healthcare’s highest need, highest cost beneficiaries experiencing homelessness. An evaluation of that demonstration now examines the theory that when individuals with significant health costs who also experience homelessness are identified and have access to affordable housing and wrap around services, they will experience increased housing stability and improved health, and decrease the use of costly, crisis health care services.
A five year Randomized Control Trial (RCT) evaluation of CSH-SIF has been conducted by an interdisciplinary team of researchers from New York University, led by Principal Investigator Beth C. Weitzman, PhD. This evaluation is the first RCT evaluation of a national supportive housing demonstration of this scale.
Through the CSH Social Innovation Fund Initiative (CSH-SIF) nonprofits in four communities are implementing an enhanced supportive housing model. Programs across all four demonstration sites encompass the following five elements found to be essential to the achievement of Initiative goals:
With an initial target of housing 549 people nationally, all four CSH-SIF sites far exceeded their original targets.
Total Number Housed by CSH-SIF
Housing Retention Rate
Based on program data
Primary Health Insurance Retention Rate
Based on program data
726
86%
93%
The New York University evaluation contains several key components to assess both program implementation and impacts across sites, including a series of visits to all program sites, a pre/post participant survey, and cost effectiveness and impact analyses.
In 2012, Mecklenburg County (North Carolina) Community Support Services (CSS) leadership was researching effective jail diversion models that would reduce recidivism and save public dollars, and discovered CSH’s Frequent User Systems Engagement, or FUSE.
Based on what they learned from CSH, Mecklenburg County created a local FUSE initiative known as MeckFUSE – an interagency effort providing supportive housing to individuals that cycle between the criminal justice and homeless shelter systems in the County, home of the City of Charlotte.
The Department of Criminal Justice & Criminology at the University of North Carolina at Charlotte has now thoroughly evaluated MeckFUSE and today released the results of its study.
The three-year process and outcomes evaluation demonstrated improved housing stability, reduced rates of jail and shelter utilization, and reduced hospital charges. Overall, MeckFUSE is deemed successful in reducing system utilization costs among participants.
Key findings of the MeckFUSE evaluation conclude:
Nearly all (98%) of MeckFUSE participants had an adult conviction record with a mean of approximately 13 adult convictions.
Over 90% of participants reported spending more than 12 months in a homeless shelter or other place not meant for habitation. Of those, the mean time of homelessness was approximately 11 years.
MeckFUSE participants demonstrated a 90% two-year housing retention rate.
MeckFUSE participants demonstrated significant reductions in shelter usage (87%), ambulance service charges (24%), and hospital charges (43%).
Housed participants were arrested significantly less than a comparison group (4.5 vs. 9.3 arrests) and had much longer average times to re-arrest post-housing.
A majority of participants indicated that MeckFUSE had significantly improved their lives and relationships with their families. For example, 57% of the participants indicated that the program helped them improve relationships with their children.
The evaluation, which followed program participants for two years and used a quasi-experimental matched comparison group design, is noteworthy because there are few studies that follow participants longer-term. One such study reviewed New York City’s FUSE program.
Together, the studies make a strong case for continuing to serve frequent users of high cost systems, and to providing housing and supportive services with no pre-conditions for entry into the program.
Mecklenburg County plans to continue the MeckFUSE program, operated through a contract with Urban Ministry Center, an interfaith community agency working to end homelessness.
Description: CSH is seeking a subcontractor(s) to produce a homelessness study that will create a baseline of the housing needs of families who are experiencing homelessness and are at risk of homelessness in Chicago. It is expected that this study and report will use the Homeless Management Information System (HMIS) and the Chicago Public School’s Students in Transitional Living Situations (STLS) database as primary data sources. The study will address the following key analytical questions: How many families are currently experiencing literal homelessness; How many families are currently At-Risk of Homelessness per HUD including in “doubled-up,” facing imminent eviction, and residential instability such as moves in past 60-days; How many families do we anticipate will experience homelessness within the next year; and, What are the projected housing needs of those that will enter homelessness in the coming year? The research partner(s) will collaborate with the research Advisory Council as well as with CSH staff.
Multiple entities are encouraged to collaborate on a single proposal outlining roles, responsibilities, and costs.
Planned activities:
Secure Data Sharing Agreements
Link and clean data
Analyze data
Produce report of findings and future research questions
Expected Outcomes, Milestones, and Deliverables:
Deliverable 1: Complete dataset between homeless systems and school systems and other databases as applicable and available
Deliverable 2: Interim report on data after linking and cleaning to indicate scale and limitations of initial findings to gather feedback
Deliverable 3: Final report on findings on key analytical questions
Funding Available:
An amount not to exceed $46,250 is available for this project. Respondents should detail the amount of leveraged funding they are able to seek to bring to the project and specifically that leveraged dollars will support the key findings sought, at a minimum.
Application Process and Vendor Requirements:
To apply for this opportunity email Betsy Benito at betsy.benito@csh.org by March 17, 2017.
Applications received before the deadline will be evaluated based on the following criteria:
Demonstrated successful performance of substantially similar work
Ability to secure data sharing agreements with stated data sources
Detailed Project timeline, and ability to complete the report by December 2017
Detailed approach to key analytical questions
Roles and responsibilities of staff funded by the project and staff leveraged to the project through other sources
Outline an approach to securing housing assessment information from families that are in the CPS STLS program, but may not have formal assessment information in HMIS. Please provide a separate cost estimate for this component, if applicable.
Please note that CSH requires subcontractors, including individuals and sole proprietors, to carry workers’ compensation insurance while performing work under a CSH subcontract. CSH subcontractors cannot have existing, pending or expired debarments that preclude them from doing business with the United States government and cannot have convictions for, nor have any pending indictments for, fraud or a criminal offense in connection with a public contract or subcontract.
Final MeckFUSE Outcome Evaluation Report Sept 2017 (002).pdf