CSH Holds Convening for Social Innovation Fund Subgrantees and Demonstration Sites

On October 10 and 11, CSH gathered roughly 55 individuals representing subgrantees, partners, advisors, investors and key stakeholders for the first annual in-person convening of our Social Innovation Fund Initiative, which strives to demonstrate the potential of supportive housing connected to medical homes as a tool for improving health while reducing Medicaid and health care costs among homeless “super users” of emergency departments, hospitals and other crisis health services use.

On the first of the two-day convening, participants shared and discussed key considerations and strategies for successfully engaging and increasing housing and health stability among homeless “super user” clients, including hearing from three experts operating similar program models.

Members of the evaluation team at New York University also engaged subgrantees and participants in further explicating the Theory of Change underlying the program model. Participants also discussed various aspects of program implementation including coordinating property management and supportive services, providing health care using a patient-centered health home approach, and engaging Medicaid and managed care to pay for services in supportive housing.

The second day began with a tour of subgrantee Tenderloin Neighborhood Development Corporation’s Kelly Cullen Community (KCC).  KCC is the San Francisco YMCA building rehabilitated into a 174 apartment supportive housing building co-located with a community health center and fitness center, which will provide both housing and primary and behavioral health services to the homeless high utilizers of crisis health services for CSH’s SIF demonstration.  Following the tour, CSH’s subgrantees heard from a panel of health and housing policy experts regarding opportunities, challenges, and strategies for leveraging mainstream health and housing resources to sustain and scale their models.  The remainder of the convening gave four subgrantee teams the opportunity to meet and strategize on next steps.

Key insights and highlights from the convening’s discussion include:

  • Safe, affordable, and beautiful housing and client’s housing stability plays a central role in improving health status and reducing emergency department and hospital visits among clients with complex health conditions
  • A combination of persistence and a respectful, non-judgmental attitude is critical to engaging and building trust with clients
  • How motivational interviewing, informed by a harm reduction philosophy, can help clients overcome ambivalence to engage in services and make healthier choices
  • There remains a significant gulf between what is recognized as healthcare and what really impacts the health, especially among people with complex needs.  CSH’s SIF Initiative attempts to bridge that gulf, but must confront a significant cultural and philosophical divide between traditional medical and healthcare practice and supportive housing’s approach.
  • The highly intensive approach to case management in supportive housing involving high degree of face-to-face contacts, involving techniques like motivational interviewing techniques differs significantly from the type of care coordination and care management models familiar to the health and medical sector
  • Supportive housing, while highly successful in ending homelessness and addressing mental health and substance abuse, is seldom accustomed or equipped to deal with chronic disease and shifting health service use from emergency department visits to primary and preventive care.
  • Partnerships between supportive housing providers and community health centers and hospitals is critical to providing a more comprehensive approach to addressing homelessness, behavioral health conditions, and chronic illness, but is only the first step.  More specifics are needed around the process and approach by which these partners will coordinate and collaborate in delivering care and services.

Overall, this first annual convening was a great success, formally “kicking off” initiative implementation, bringing to the surface critical issues and challenges facing CSH, its subgrantees, and the evaluation, and inspiring initiative partners to engage in the challenging but rewarding work ahead.  As one participant reflected, “I feel like we… have the in front of us the opportunity to really change the way that homelessness and supportive housing is viewed on a national level.  I truly believe that it is the opportunity of a lifetime and I have a lot of confidence that we will collectively succeed in changing the face of homelessness and housing.”

CSH looks forward to working with all our initiative partners over the next few years to build an integrated health and housing solution that can both bend the Medicaid cost curve and restore stability, health, and hope to the most vulnerable men and women experiencing the dual crises of homelessness and chronic illness.

view photos of the event 

Guest Blog by Dr. Maria Raven

Dr. Maria Raven is an Assistant Professor in the Department of Emergency Medicine at the University of California, San Francisco. She completed her emergency medicine residency training and a CDC-funded Fellowship in Medicine and Public Health Research at Bellevue Hospital/New York University. While on faculty, she oversaw the implementation of NYC Health and Hospital Corporation’s State Department of Health-sponsored Chronic Illness Demonstration Project. At UCSF, Dr. Raven works clinically in the Emergency Department at Moffitt-Long, and conducts research related to emergency medicine payment policy and frequent users of the health system. She also works with the San Francisco Health Plan to assist with management of their highest cost members. 

 

I recently co-authored a report published by the United Hospital Fund entitled Time and Again: Frequent Users of Emergency Department Services in New York City.  We found that 11 percent of all emergency department users with two or more visits experienced at least one move between neighborhoods, and that moves increased with increased ED use in a given year.  These moves are likely a marker for housing instability and homelessness.  Recent literature has supported the idea that provision of supportive housing for heavy users of health care services who are homeless can result in decreased health care utilization and costs.  As a result, policy makers and planners are beginning to realize that for at least some populations, solving homelessness could have an added benefit: bending the health care cost curve.

To date, separate and restricted funding streams have made the integration of housing and health care challenging.

  • How can we make meaningful connections for patients, share data, and integrate services across siloed systems of care?
  • When someone is discharged from the ED or the hospital and that person is homeless, whose obligation is it to assure continuity of care, which can include efforts towards housing placement or services provision within supportive housing or shelter?
  • How can providers outside of the healthcare system obtain real-time information about what occurred in the hospital given strict patient privacy laws?

These are questions that must be addressed. CSH understands this, and is helping to lead the effort to better integrate state Medicaid programs and housing.

In New York City, I recently oversaw one of six State Department of Health sponsored Chronic Illness Demonstration Projects (CIDPs) designed to improve care and reduce costs for high risk, high cost Medicaid beneficiaries. Based on pilot work, we understood that a significant percentage of our enrollees would be homeless or precariously housed. We addressed this issue by employing a full time Housing Coordinator who thoroughly understood both the health care system and the housing system in New York and worked within both settings. We established data sharing agreements that allowed for information exchange between the public hospital system and multiple homeless services agencies, and our program staff followed patients across systems of care, from the emergency department or hospital to the shelter, street, or supportive housing unit. By providing accountability across the entire spectrum of care, and enabling our staff to work across silos, we have been able to show that over time we can decrease health care costs while increasing connections to outpatient care. For the patients in our program that were homeless, we hit severe roadblocks during program implementation that hindered our ability to rapidly house eligible enrollees: Section 8 vouchers were abolished, work advantage vouchers (New York City’s pilot short-term homeless rental assistance) were rescinded, and there was little to no housing stock. But for those we housed—and I firmly believe that through our advocacy, more of our enrollees were housed more quickly that they would have been without our services—we witnessed notable reductions in hospital days and ED visits by the end of the first year.

Most recently, New York State submitted an application for a Medicaid waiver from the federal government, which includes a Medicaid Supportive Housing Expansion program that will dedicate $150 million annually to expand access to supportive housing. Researchers, providers, and advocacy organizations must continue to highlight the social, health, and fiscal benefits of these connections so that innovative proposals such as these will continue to support federal, state, and local efforts to bridge the worlds of housing and health.

Meet the CSH Social Innovation Advisory Board

Anne Fletcher, Social Science Analyst at U.S. Department of Housing & Urban Development
In this position, Anne Fletcher helps to develop the Department’s research agenda relating primarily to issues around homelessness and housing for persons with disabilities. She plans and manages contracted research projects in those policy areas.

Jennifer Ho, Deputy Director, United States Interagency Council on Homelessness In her first six months at USICH, Jennifer Ho shepherded the development of the Opening Doors, the nation’s first‐ever comprehensive federal plan to prevent and end homelessness. Jennifer is the USICH liaison to 13 federal agencies, including the U.S. Departments of Health and Human Services, Education, and Agriculture, and the Social Security Administration, and she is the point person on issues related to family and youth, as well as chronic homelessness.


Gavin Kennedy, Director of the Division of Long-Term Care Policy, Office of Disability, Aging, and Long-Term Care Policy (DALTCP) 
In addition, as division director, Gavin helps lead ASPE’s work in public financing of long term services and supports; Medicare/ Medicaid nursing facility payment and quality improvement policy; the Medicare-Medicaid “dually-eligible,” and, generally, policies affecting the delivery of health care and supportive services for people with functional impairments and long-term care needs.

Kathy Moses, MPH, Senior Program Officer, Center for Health Care Strategies (CHCS) In this role, Kathy Moses provides technical assistance and strategic consultation to Medicaid state agencies as they develop, implement, measure and evaluate health care initiatives aimed at improving quality of care for people with chronic illnesses, disabilities and the elderly. Her particular areas of expertise are in care management and quality improvement.

 

Mike Nardone, Principal, Health Management Associates Mike comes to HMA with more than 30 years experience in health and human services, having held positions at the state, local, and national levels. Most recently, he served as acting Secretary of the Pennsylvania Department of Public Welfare (DPW), a $21-billion, 17,000-employee department with responsibility for the state’s major health and human services programs, including Medical Assistance.

 

Bill Pitkin, Director, Domestic Programs, Conrad N. Hilton Foundation
Bill Pitkin oversees the planning, development, implementation and evaluation of the Conrad N. Hilton Foundation’s domestic priority areas. He led the development of the Foundation’s strategy for addressing chronic homelessness in Los Angeles and continues to have direct oversight over that strategic initiative.

 

 

Mohini Venkatesh, Senior Director of Public Policy, National Council for Community Behavioral Healthcare Ms. Venkatesh serves as the staff policy liaison to the National for Community Behavioral Healthcare network of associations throughout the states, conducts federal legislative analysis on health reform and other policy issues, and manages several leadership and quality improvement initiatives

 

 

Ann Woodward, Chief Operating Officer and Interim Executive Director, Melville Charitable Trust 

Ann brings to the grant-making and community investment work of the Trust over 25 years experience in improving outcomes for vulnerable populations through non-profit affordable and supportive housing, community development, and public programs that support alternative education and employment training in low income communities.

 

 

more about the csh social innovation fund initiative

Connecticut Health Foundation is the Newest Funder for Social Innovation Fund Initiative

The Connecticut Health Foundation has joined several foundations as a partner and supporter of CSH’s Social Innovation Fund Initiative to improve health and reduce costs among vulnerable men and women whose complex health conditions and poor access to health and housing contribute to rising health care costs.  This new support builds upon the CT Health’s prior support to CSH in Connecticut, which helped to increase collaboration and services integration between supportive housing and Federally Qualified Health Centers.

“The Connecticut Health Foundation is committed to eliminating racial and ethnic health disparities in Connecticut through advancing solutions, systems integration and rigorous evaluation. CT Health is thus pleased to be a funding partner of the Connecticut Integrated Healthcare and Housing Neighborhoods Social Innovation Fund Initiative. People of color are a disproportionate segment of the homeless population living with chronic conditions. Supportive housing that integrates a culturally and linguistically appropriate health home that addresses physical and mental health needs is a promising model for reducing health care disparities while reducing costs,” says Elizabeth Myung Sook Krause, Senior Program Officer, Connecticut Health Foundation.

The CT Health Foundation has been a catalyst for reforming the state’s health care system to increase health equity and quality.  CSH is proud to have them as a partner.

CSH Named $2 million Awardee of “NEXT Opportunity Award”

CSH has been awarded $2 million by the nation’s largest awards program for community development financial institutions (CDFIs), the Wells Fargo NEXT Awards for Opportunity Finance. CSH will use the $2 million award to expand lending activities in communities that have high levels of chronic homelessness and the greatest need for supportive housing through a National Loan Fund. The fund will enable CSH to expand into 10 underserved markets and will spur the creation of nearly 10,000 supportive and affordable housing units over 10 years.

The Wells Fargo NEXT Awards for Opportunity Finance are presented by Opportunity Finance Network with support from Wells Fargo, The Kresge Foundation, and the John D. and Catherine T. MacArthur Foundation. The NEXT Awards is the nation’s largest awards program for the CDFI industry. It recognizes innovative and high-impact CDFIs that bring needed financing to low-income, low-wealth, and other disadvantaged people and communities across the U.S.

“CSH is honored to receive a Wells Fargo NEXT Award for Opportunity Finance. We will use the award to expand on our 20 years of success using supportive housing to build strong, healthy communities,” says CSH President & CEO, Deborah De Santis.

See a video celebrating CSH’s work as a CDFI and our Next Award win (our video is in first row).

Awardees were honored at a celebration on October 16 at Opportunity Finance Network’s annual Conference in San Antonio, TX.

read the press release

Meet the CSH Board: Stephen Norman

Q:  Why did you join the CSH Board?
I joined the CSH board because I believe deeply in the mission and in the approach that CSH is taking to address homelessness. It is an extraordinarily talented staff and board building on twenty years of experience and success.

Q: What excites you the most about CSH’s work in supportive housing?
Providing communities with the tools and support needed to craft local solutions – and the real difference that housing makes in people’s lives.

Q: What role can public housing authorities play in supportive housing?
Housing Authorities already house many of the most at-risk households in our communities. They are taking the lead in assuring that veterans, men and women who served in our armed forces, are not left on the streets. They are working with school districts to address the growing numbers of homeless students. They are helping child welfare systems reunite parents and children. Housing alone will not provide the full answer – partnerships between housing and services are critical to assuring the success of these efforts.

Q: Where do you see the industry in 10 years?
Safe affordable housing underpins so much in our communities – health, educational success, even the ability to get a job and be self-supporting. We need better recognition of the downstream benefits, both financial and social, of assuring that everyone has a home. In 10 years I would see affordable housing and  appropriate support services integrated into the healthcare system, reducing overall healthcare costs, and available for all children – helping to promote academic success and our global economic competitiveness.

Stephen Norman is the Executive Director of the King County Housing Authority.

Housing Credit Policies in 2012 that Promote Supportive Housing

What is a leading way to promote developing supportive housing across the nation?  To create incentives in Qualified Allocation Plans (QAPs).  QAPs are the document that housing credit agencies use to state their priorities and regulations for allocating low income housing tax credits.  CSH is pleased to present “Housing Credit Policies in 2012 that Promote Supportive Housing.”  This new report builds on our assessment of 2010 and 2011 QAP policies and examines the strategies housing credit agencies adopted to foster and encourage supportive housing development, highlighting significant changes made within QAPs this year.  It also describes trends in the industry, and calls out specific examples of policies that improve the production, quality or financing of supportive housing.

CSH Releases New PHA Toolkit for Supportive Housing

Public Housing Agencies across the country increasingly want to improve opportunities for homeless and other vulnerable households. Today, CSH released a new interactive technical assistance tool to help. The CSH PHA Toolkit is a guide to how PHAs can work with service providers to create supportive housing opportunities for the people who need them most. Chase Bank provided support to make the PHA Toolkit possible.

Online now at csh.org/phatoolkit, this new resource provides tools, examples and advice for PHAs venturing into or expanding work in supportive housing. Everything PHAs need to create supportive housing is just a click away, including:

  • Promising practices
  • PHA profiles
  • Sample documents and agreements
  • Glossary of service terms
  • Partnership models

CSH is working with PHAs around the country to help them get started with supportive housing. Learn more about our work at csh.org/pha.

Open the PHA Toolkit Now!

PHA Toolkit for Supportive Housing

Public Housing Agencies across the country increasingly want to improve opportunities for homeless and other vulnerable households.  The CSH PHA Toolkit is a guide to how PHAs can work with service providers to create supportive housing opportunities for the people who need them most.

The PHA Toolkit is sponsored by  

Housing Credit Policies in 2012 that Promote Supportive Housing

CSH is pleased to present “Housing Credit Policies in 2012 that Promote Supportive Housing,” available for download at csh.org. This new report builds on our assessment of 2010 and 2011 Qualified Allocation Plan (QAP) policies and examines the strategies housing credit agencies adopted to foster and encourage supportive housing development within QAPs for the Low-Income Housing Tax Credit (Housing Credit), highlighting significant changes made within QAPs this year. CSH examined 54 QAPs for this report.