OSF Grants $150,000 to CSH for FUSE Replication

OSFThe Open Society Foundations (OSF) U.S. Programs initiative supports efforts to advance equality, fairness, and justice with a focus on the most vulnerable and marginalized communities and the most significant threats to open society in the United States today. OSF works to further a vibrant democratic society in which all people can meaningfully participate in its civic, economic, and political life and to ensure that the core institutions of civil society are effective and accountable to the public.

Areas of particular emphasis in U.S. Programs’ grant-making and other activities include:

  • The advancement of effective and fair criminal justice and drug policies,
  • Support of the rights of racial minorities and other vulnerable groups;
  • Support of institutions and practices that advance a more informed and engaged public and responsive and effective government.

OSF’s recent contribution of $150,000 to CSH to promote a scaled replication and the sustainability of the FUSE (Frequent Users/Utilizers Systems Engagement) model will help ensure that more people leaving our jails and prisons will have a real chance to become a part of the communities in which they live. Because of the generosity of OSF and others, CSH is able to recreate FUSE in more communities across the country.

FUSE is a CSH signature accomplishment that helps communities identify and engage high utilizers of public systems and place them into supportive housing in order to break the cycle of repeated use of costly crisis services, shelters, and the criminal justice system. In the FUSE model, supportive housing serves to smooth the transition from institution to community, promoting a transformation that serves those released from jails and prisons, and the general population, by improving lives and public safety.

The critical support of OSF and our partners will allow CSH to aggressively pursue our vision to create additional policy and resource tools, such as FUSE, that encourage cross-system collaboration and allow innovative responses to complex social problems.


CMS Issues Bulletin on Using Medicaid for Supportive Services

CMSThe Centers for Medicare and Medicaid Services (CMS) Center for Medicaid and CHIP Services (CMCS) has released an Informational Bulletin intended to assist states in designing Medicaid benefits, and to clarify the circumstances under which Medicaid reimburses for certain housing-related activities, with the goal of promoting community integration for individuals with disabilities, older adults needing long term services and supports (LTSS), and those experiencing chronic homelessness. Consistent with statute, CMS/CMCS can assist states with coverage of certain housing-related activities and services.

Read the full CMS/CMCS Informational Bulletin here.

For more information on how states are currently using Medicaid in supportive housing, see CSH’s four new resources, released earlier this month.

Read our joint statement with the National Alliance to End Homelessness, the Technical Assistance Collaborative and the National Health Care for the Homeless Council.

OrgCode, Community Solutions & CSH Launch Next Step Tool for Youth

The Next Step Tool for Homeless Youth

The Next Step Tool for Homeless Youth, or Next Step Tool, integrates the TAY Triage Tool, developed by the Corporation for Supportive Housing (CSH) through research by Eric Rice, PhD, Associate Professor at University of Southern California, with the VI-SPDAT, created by Community Solutions and OrgCode Consulting, Inc.

The TAY Triage Tool predicts which youth are most likely to experience long-term homelessness, essentially on a trajectory to becoming chronically homeless adults. The VI-SPDAT helps understand current vulnerabilities and risks to future housing stability, in order to support youth in ending their homelessness.

The Next Step Tool carefully merges all of these tested ideas together. Through a closed-ended survey where youth provide a yes, no or one-word answer, service providers have a better understanding of the intensity of supports to begin with when supporting the youth.  You can download the Next Step Tool at http://www.orgcode.com/product/vi-spdat/


The Youth SPDAT

To complement the launch of the Next Step Tool, OrgCode has also created a modified version of the Service Prioritization Decision Assistance Tool (SPDAT) for use specifically with youth. The Youth SPDAT was developed based on feedback from many communities using the SPDAT who identified the need for a complete assessment tool that emphasized the unique issues faced by homeless youth.

You can download the Youth SPDAT at http://www.orgcode.com/product/spdat/


CSH Transition Age Youth (TAY) Triage Tool

The CSH Transition Age Youth (TAY) Triage Tool – A Tool to Identify Homeless Transition Age Youth Most in Need of Supportive Housing – can be accessed directly here.


Harvard Releases State of the Nation’s Housing 2015

The Joint Center for Housing Studies of Harvard University has released The State of the Nation’s Housing 2015 and this is what it says about our PROGRESS IN REDUCING HOMELESSNESS and the role supportive housing is playing, effectively getting people off our streets and keeping them housed:

“The lack of affordable housing in the United States continues to leave nearly 600,000 people homeless. More than a third are people in families, including 130,000 children under the age of 18. By comparison, chronically homeless individuals (those who have been without a place to live for at least a year or have had repeated episodes of homelessness over the past few years) account for a much smaller share (15 percent) of the homeless population. Recent increases in federal funding have aided progress in reducing both homelessness overall and among the most vulnerable groups. Indeed, the number of beds in permanent supportive housing expanded 60 percent between 2007 and 2014, to over 300,000. Beds for the chronically homeless accounted for just over half of this increase. As a result, total homelessness fell 11 percent in 2007–14, the number of homeless veterans dropped 19 percent, and the number of chronically homeless individuals was down by 30 percent. At the same time, however, the number of homeless people in families declined by only 8 percent.

But the national reduction in homelessness is not apparent in all markets. Rising rents and a dwindling supply of affordable rentals continue to put people at risk, especially in high-cost locations. Indeed, total homelessness jumped by 29 percent in New York and 40 percent in Massachusetts between 2007 and 2014. The increase in the District of Columbia was even larger, at 46 percent. Family homelessness is particularly acute in major cities, which were home to 45 percent of this population in 2014. New York City headed the list with 41,600 homeless people in families, or nearly 20 percent of the national total.”


New Markets Tax Credits Allocated to CSH

CSH Awarded $40 Million New Markets Tax Credits

Today, the U.S. Treasury Department’s Community Development Financial Institutions (CDFI) Fund announced it has awarded $40 million in New Markets Tax Credits (NMTC) to CSH as part of the 2014 round.

“The Department of Treasury has given us the tools to leverage even more resources to spur the creation of supportive housing,” said CSH President and CEO Deborah De Santis. “Not only will we be able to create the dynamic to house vulnerable people facing instability, this award will help us fulfill our goal of bringing healthcare services to hundreds more who need to access it.”

De Santis explained NMTC allocations can be used to develop facilities such as health care centers, which complement the medical and mental health services often made available to residents of supportive housing.

Thus far, CSH has used NMTC investments to leverage and add to other resources, which in turn have created about 200 units of supportive housing across the country, and enabled 15,000 healthcare visits for those facing homelessness and other forms of housing instability. In addition, CSH investments have generated approximately 800 high-quality permanent and construction jobs in communities.

To learn more about our use of NMTC to promote supportive housing, please see profiles of the Bell Building in Detroit, MI and Paseo Verde in Philadelphia, PA.

With the new award, CSH will address a number of supportive housing projects currently in the pipeline for development and estimates adding another 150 – 200 units of affordable housing, including supportive housing, and an additional 100,000 – 125,000 healthcare visits for those facing homelessness and housing instability.

“The investments made possible by today’s awards will have significant impact nationwide,” said Annie Donovan, Director of the CDFI Fund.

To learn more about CSH’s New Markets Tax Credit strategy visit our lending page or contact our Community Investment Team.

“CSH gets it when it comes to supportive housing and they are willing to work in partnership with developers to tailor their support and products to get the deal done.” Joe Heaphy, NSO (Bell Building) Vice-President of Real Estate Development and Management

New Medicaid Resources from CSH Focus on State Efforts

CSH has created four new resources examining  how states are using and are looking to use Medicaid for supportive housing. The new resources include a deeper look at New York State’s activities, a new Crosswalk focused on Arizona, and two new overviews on Medicaid usage for housing unit creation and supportive housing services.



As states and communities look to target supportive housing for high cost, unstably housed individuals and families, the lack of available housing subsidies becomes readily apparent. This population not only needs intensive services and supports, they require a housing subsidy to make available housing affordable.

Federal housing resources such as Section 8 Housing Choice Vouchers have not grown to meet the need and with housing costs always rising, the reach of these programs has been diminishing in recent years. Service delivery and financing improvements alone will not allow health care payers to maximize health cost reductions for this segment of the population. Housing and the subsidies needed to access it are also essential.

Recognizing this, Medicaid agencies and health system payers are experimenting with ways to create state and local housing subsidy programs for specific Medicaid subpopulations. Federally, Medicaid resources are not used for housing capital development or rental assistance. However, state and local entities have flexibility with their Medicaid resources and this is leading to innovative strategies. This resource summarizes initiatives in New York, Illinois and Minnesota to couple housing and Medicaid reimbursed services together for people who need supportive housing to stabilize and reduce health system


States recognize that supportive housing directed at the right population can reduce Medicaid spending. They also understand supportive housing services need to be financed in a way that is more sustainable than through short-term government and philanthropic grants. Therefore, states, localities and health services payers such as managed care organizations are experimenting with ways to more comprehensively finance outreach and engagement, tenancy supports and general case management.

This resource highlights actions states and other entities have taken to improve delivery and financing of the services delivered by supportive housing providers.


Achieving New York’s Medicaid Redesign Goals through Supportive Housing

As New York State (NYS) continues to restructure how health care services are delivered under its Medicaid program, there is increasing opportunity to better position the supportive housing industry to help the state meet its desired goals of achieving the Triple Aim: improved health outcomes, quality and reduced health care costs for some of its most vulnerable members. This paper summarizes the state’s efforts under the Medicaid Redesign Team (MRT) to reduce avoidable health care expenditures and increase quality of services using supportive housing as an intervention to stabilize its neediest, high-cost utilizers of health care. It also examines the opportunities and challenges in leveraging Medicaid as a potential funding source for supportive housing services.


IMPROVING ACCESS TO MEDICAID BEHAVIORAL HEALTH SERVICES For Arizona Medicaid Beneficiares Needing Supportive Housing

As evidence continues to establish supportive housing as an intervention that stabilizes people with chronic illnesses, states are exploring ways to ensure Medicaid programs cover the services that supportive housing residents need. To this end, CSH has analyzed Arizona’s Covered Behavioral Health Services Guide and accompanying documents to determine the extent to which Medicaid benefits extend to non-SMI Medicaid members living in supportive housing and offers recommendations to align state Medicaid policy and supportive housing services.

Houston Ends Veteran Homelessness


CSH President & CEO Deb De Santis with Houston Mayor Annise Parker, Houston Coalition for the Homeless President & CEO Marilyn Brown, and officials from the US Department of Veterans Affairs and US Department of Housing and Urban Development.






Deb De Santis, President & CEO of CSH, speaks last September in Houston, Texas, lauding the community partnership that worked together to build an infrastructure to quickly and effectively address the housing and services needs of veterans experiencing homelessness.





“More so than in any community in this country, the people of Houston came together to end veteran homelessness. This milestone reflects the countless hours and hard work of those on the ground – the members of the Coalition for the Homeless of Houston/Harris County and The Way Home Campaign – who broke down barriers, built new relationships, innovated, and are now ensuring a future where no veteran will ever be shut out from housing or services again.” Deb De Santis, CSH President & CEO




CSH Welcomes Four New Board Members

CSH is pleased to announce the addition of four outstanding individuals to our dynamic board of directors:

  • Don Falk, President of the Tenderloin Neighborhood Development Corporation
  • Dorothy Edwards, Los Angeles Community Advocate
  • Michelle Norris, President, National Church Residences Development Corporation and
  • Dr. Jim O’Connell, President, Boston Health Care for the Homeless Program


Don Falk
As Executive Director of Tenderloin Neighborhood Development Corporation (TNDC), Don leads a community-based, non-profit housing development, management and social services agency in San Francisco with 300 employees and 30 properties containing over 2500 homes. Of the nearly 3500 people TNDC houses, 25% came to the organization out of homelessness. From 1982-1994, Mr. Falk held a variety of positions with Jubilee West, a neighborhood based nonprofit that provides services and housing in West Oakland. Mr. Falk earned a Master’s in Public Policy from the University of California, Berkeley, and a BA with honors in Economics and Urban Studies from Oberlin College. He chairs the Community Leadership Council and serves on the Board of Directors of Enterprise Community Partners, and serves on advisory boards of NeighborWorks America, St. Francis Memorial Hospital Foundation and the Federal Home Loan Bank of San Francisco.  He is the past president of the Nonprofit Housing Association of Northern California, on whose board he served for seven years. TNDC is a CSH Social Innovation Fund grantee.

Dorothy Edwards
Dorothy is formerly homeless and is currently part of our Los Angeles supportive housing advocate program in which she speaks to elected officials both locally and at the state level about the impact of supportive housing. The following paragraphs are from a USA Today article highlighting mental illness in America:

Dorothy Edwards knows the despair and paranoia that cripple the mentally ill from seeking help and finding an apartment. For eight years, Edwards, 56, wandered the streets of Pasadena, Calif., sleeping in alleys, scouring Dumpsters for scraps of food and smoking meth to fend off a crushing depression. Her teeth were rotting, and sores broke out all her over body. She was sexually assaulted repeatedly and had her belongings stolen multiple times.

When things got truly bleak, Edwards would check herself into the psych ward of a hospital, only to be back on the streets within days. Various friends ravaged emotionally by the homeless life had flung themselves off the Colorado Street Bridge in Pasadena, known locally as “suicide bridge.” She considered using the bridge herself, she says.

“It was looking pretty good to me,” Edwards says. “I had run out of options.”

Shortly after, she was approached by a worker from Housing Works, a Los Angeles homeless outreach center. The worker escorted Edwards to a processing center, where counselors diagnosed her with depression and post-traumatic stress disorder, found her an apartment and assigned her a caseworker.

Today, Edwards lives in a one-bedroom apartment in Pasadena with her 8-year-old mixed-breed dog, Gunner. The paranoia and anxiety still creep in periodically, especially late at night, but the medications and a watchful caseworker help her through it.

Michelle Norris
Michelle joined National Church Residences in 1993 as Director of Corporate Financial Services. She later became Chief Operating Officer of Housing Management, overseeing the management operations of National Church Residences’ affordable housing portfolio. She was promoted to Chief Development Officer, overseeing the team that specializes in development of all new National Church Residences products. This includes HUD 202 construction, Low-Income Housing Tax Credit new construction, acquisitions and substantial rehabs. In 2012, she was promoted again to Senior Vice President of Development and Public Policy. She was named President of National Church Residences Development Corporation in 2014. In her current role, Michelle is responsible for the growth of National Church Residences’ affordable housing portfolio. This includes continued development of new construction and preservation using the low-income housing tax credit program. In addition, she oversees the creation the organization’s “Affordable Housing Investment Fund” as well as disbursements from the fund to acquire other affordable housing communities. She also oversees the public policy efforts on behalf of the organization. Michelle holds a bachelor’s degree from Miami University in Ohio. She currently serves on the boards of National Affordable Housing Trust (NAHT) and Stewards of Affordable Housing for the Future (SAHF). Michelle also serves as president of the Ohio Housing Council (OHC) and is a past president of the National Affordable Housing Management Association (NAHMA). In addition to her work in affordable housing, Michelle enjoys long distance running, backpacking and other outdoor activities. She is an active member of the Vineyard Columbus Church.

Dr. Jim O’Connell
Jim graduated summa cum laude from the University of Notre Dame in 1970 and received his Master’s degree in theology from Cambridge University in 1972. After graduating from Harvard Medical School in 1982, he completed a residency in Internal Medicine at Massachusetts General Hospital. In 1985, Jim began fulltime clinical work with homeless individuals as the founding physician of the Boston Health Care for the Homeless Program, which now serves over 12,000 homeless persons each year in two hospital-based clinics (Boston Medical Center and MGH) and in more than 70 shelters and outreach sites in Boston. With his colleagues, Jim established the nation’s first medical respite program for homeless persons in September 1985 with 25 beds in the Lemuel Shattuck Shelter. This innovative program now provides acute and sub-acute, pre- and post-operative, and palliative and end-of-life care in BHCHP’s free-standing 104-bed Barbara McInnis House. Working with the MGH Laboratory of Computer Science, Jim designed and implemented the nation’s first computerized medical record for a homeless program in 1995. From 1989 until 1996, Jim served as the National Program Director of the Homeless Families Program of the Robert Wood Johnson Foundation and the U.S. Department of Housing and Urban Development. Jim is the editor of The Health Care of Homeless Persons: A Manual of Communicable Diseases in Shelters and on the Streets. His articles have appeared in the New England Journal of Medicine, the Journal of the American Medical Association, Circulation, the American Journal of Public Health, the Journal of Clinical Ethics, and several other medical journals. Jim has been featured on ABC’s Nightline and in a feature-length documentary entitled “Give Me a Shot of Anything.” He has received numerous awards, including the Albert Schweitzer Humanitarian Award in 2012 and The Trustees’ Medal at the bicentennial celebration of Massachusetts General Hospital in 2011. Jim is president of BHCHP and an assistant professor of medicine at Harvard Medical School.

Subcontracting Opportunity for Department of Housing and Urban Development Funded Work

CSH is currently applying to the HUD Office of Community Planning and Development’s Community Compass Technical Assistance and Capacity Building funding opportunity and are seeking subcontractors  to add to our application.  According to the Notice of Funding Availability (NOFA), the technical assistance will consist of collaboration between the awardee, HUD, and its customers to build knowledge, skills, tools, and systems within communities through efforts across HUD programs and program offices.

In order for consideration to become a subcontractor and participate in this work, we will need you to complete and return the below application and forms no later than Monday, June 23, 2014.

You may apply as an individual subcontractor or as an organization, including up to 6 staff members in the application.  The following forms are included:

Attachment A: Commitment Letter (applying as: individual/ organization)

Attachment B: Subcontractor Application (applying as: individual/ organization)

Attachment C: Staff Experience and Expertise (applying as: individual/ organization)

Attachment D: Certification Form for Cost Reimbursable No Fee (required only for federally-audited applicants)

Experience Template (applying as: individual/ organization)

Please fully complete the included forms as well as submit your resume (or if applying as an organization, resumes for up to 6 proposed staff members included in the Staff Experience and Expertise matrix and the Organization Experience matrix) and a 2 paragraph description of your (or your organization’s, if applying as an organization) core competencies and accomplishments to Margaret Djekovic at margaret.djekovic@csh.org no later than Monday, June 23, 2014.  All of the application information and forms must be completed in order to be considered.

We will contact you by July 23, 2014 regarding the determination of adding you as a CSH subcontractor.  Please note that CSH requires subcontractors to maintain for itself and its employees insurance coverage, including but not limited to worker’s compensation, automobile liability insurance, general liability coverage, excess liability coverage (when applicable) and professional liability coverage (when applicable).

If you have any questions, please feel free to e-mail Margaret at margaret.djekovic@csh.org.

CSH’s Sarah Gallagher Shares her Reflections on the SIF Initiative and Progress to Date

By Sarah Gallagher, CSH Director in Connecticut and SIF program manager

Sgallagher headshotOver the past year, I have been working with four dedicated teams across the country in implementing CSH’s Social Innovation Fund Project to demonstrate that supportive housing is a solution to addressing the needs of Medicaid’s highest need, highest cost beneficiaries experiencing homelessness. This demonstration began in 2011 and over the past two years, we’ve had our share of challenges and successes.

When we started on the SIF journey, CSH was looking to develop housing solutions for the cohort of homeless individuals with chronic health conditions who are super utilizers of crisis health services.  This group is highly vulnerable, having high rates of serious mental illness, issues with substance use, as well as higher rates of chronic medical conditions such as diabetes and hypertension.

They face the double-jeopardy of homelessness, which often exacerbates these complex health needs, increasing exposure to risky behaviors and preventing access to care and treatment adherence.  The result is high utilization in emergency services with poor health outcomes and rising health care costs, particularly Medicaid.

Our solution to this complex problem which we are testing through the SIF brings together the best of what we know works in ending homelessness with some of the most innovative solutions for improving health and lowering health care costs.  We are bringing together supportive housing, using a housing first approach that helps people move directly into affordable housing and then offers voluntary services to support housing stability, coupled with data driven targeting to identify and engage super-utilizers.  Additionally, the model is underscored with the added component of care coordination, patient navigation, and direct linkages to primary and behavioral health care.

The development of the CSH Health and Housing model is a direct response to the expansion of Medicaid coverage, and the active search for solutions to achieve the Triple Aim of better health outcomes, better experience with care, and lower costs.  We know that for Medicaid’s highest utilizers who experience unstable housing and homelessness, achieving the Triple Aim is only be possible if we can address housing needs.  We want to know if supportive housing—adapted as a more intentional health care intervention—could be a strategy and solution for achieving better outcomes and Medicaid cost containment.  In turn, we what to explore how can Medicaid become a means of solving at least one half of the supportive housing financing puzzle… services.

The Corporation for National and Community Service’s Social Innovation Fund seeks out innovative solutions to some of the toughest social problems in America.  SIF aims to catalyze public and private investment to support, test, and scale data driven, effective solutions.

Through SIF, CSH saw a rare opportunity to broaden the conversation around the integration of health and housing and build the business case to a scale our efforts through new financing mechanisms available via Medicaid.

To date, 308 people have been placed in housing through SIF with a housing retention rate of 95% thus far.  All sites have been able to utilize data driven strategies through, either data matching or predictive algorithms, to identify the target population and to date it seems as if these efforts are useful in identifying the highest utilizers.  For example, in CT, the average annual per person Medicaid costs for the first 24 people placed in housing was $95,833—nearly $8,000 per member per month.  Through direct experience, local teams are beginning to note observable impact on tenant’s ability to stabilize, achieve their goals and reduce the number of hospital and ED visits.  For example, one individual, Scotty, in LA reduced hospital visits from 52 to 3 over a 12 month period once he was housed and working with the LA team.

And while each of our four sub grantees are working diligently to meet their targets, we know that our work does not end in 2015 when 549 high cost utilizers are housed….

The true goal in implementing SIF is to develop a model that we can replicate across the country… to create a blueprint for linking mainstream housing and health resources and scale the model until no vulnerable individual with a chronic health condition is living on the streets or in shelters.

This is what makes the evaluation component of SIF so crucial.  Through analysis of administrative data, along with qualitative analysis, the evaluation will hopefully not only demonstrate positive impacts on individual lives in LA, San Francisco, Washtenaw and CT…but will also engage new systems, document the service delivery model and provide the lessons learned and policy recommendations needed to bring SIF to scale to improve health outcomes for “super users” in all communities.

Click here to watch a recording of the January 31 webinar hosted by CSH and the evaluation team from NYU – Steinhardt School of Culture, Education, and Human Development, the Robert F. Wagner Graduate School of Public Service, and the School of Medicine