Integrated Health Center Opens in San Francisco

CSH provided $9.0 million of $51 million in New Markets Tax Credits financing to HR360, a Federally Qualified Health Center (“FQHC”) for its new 50,000-square-foot integrated health care facility which opened this week in San Francisco.

The new state-of-the-art facility replaces two outdated facilities to serve an additional 5,300 homeless and high health need patients per year with integrated medical, mental health, and social services provided by HR360. CSH also provided free technical assistance to HR360 to help to strengthen connections with supportive housing providers in San Francisco.

The ribbon cutting was celebrated by Congresswoman Nancy Pelosi and San Francisco Mayor Edwin M. Lee, and attended by more than 200 business and city leaders and HealthRIGHT 360 supporters, including CSH.

“We must be relentless in working to improve every American’s access to affordable, quality health care,” said Congresswoman Pelosi. “While we fight to defend families’ health care in Washington, San Francisco is leading the way forward with the transformational model of the Integrated Care Center we have opened today. The innovative, coordinated care model available at this center will provide world-class care and address many of the practical burdens that prevent families from receiving all the care and support they deserve.”

“Health care is a basic right, not a privilege,” said Mayor Edwin M. Lee. “We are proud to provide access to health care for all in our city. The opening of this center will provide critical, coordinated service to our most vulnerable residents, offering them much-needed opportunities to lead lives that are healthy and supported.”

“By offering integrated services all under one roof, we simplify access to care and reduce the compounding barriers preventing many from receiving vital services,” said HealthRIGHT 360 CEO Dr. Vitka Eisen.

Details about the ribbon cutting and HealthRight 360 are available here.

More information about CSH’s New Markets Tax Credits investments is available here.

Subcontracting Advertisement for Training/Technical Assistance Assignment in San Francisco under CSH’s TA Contract with Public Agency

The supportive housing project is a 52-unit supportive housing site for formerly homeless individuals with special needs, many of whom have transitioned from the shelter and who are monolingual Spanish-speaking immigrants with limited access to other subsidized housing opportunities in San Francisco. A nonprofit organization operates the project in partnership with another nonprofit organization, and the project provides onsite clinical and case management services, daily meal service, and community building support to its residents. The site is part of San Francisco’s portfolio of supportive housing.

In recent months, the supportive housing community has experienced several staff transitions with the onsite Program Manager stepping down from the position. The nonprofit that oversees property management has hired a new Program Manager, as well as a new Director of Programs.

Scope of Work
Under CSH’s Technical Assistance Contract with public agency, we propose to support the ongoing operations of the supportive housing project by providing training and technical assistance support to the staff of two nonprofit organizations, including the following activities:

  • Leadership Team Discussion. CSH and/or subcontractor staff with experience in coordinating property management and supportive services staff will facilitate an in-person discussion with property management staff from one nonprofit organization and supportive services staff from another nonprofit organization re: the following key issues to help build trust and cohesiveness among the onsite team members:  
  • Vision
  • What is working/What needs refining?
  • Roles/responsibilities
  • Meeting structure
  • Team building
  • Ad Hoc Consultation Support. CSH and/or subcontractor staff will provide consulting support to two nonprofit organization staff re: strengthening property management and supportive services coordination to serve tenant population in high quality supportive housing.
  • Resources/Training Support. CSH staff will support the two nonprofit organizations’ efforts to identify additional training and technical assistance support for the onsite staff at the supportive housing project. CSH staff will share the following informational resources re: training and technical assistance support:
  • Orientation/Introductory Material re: Supportive Housing Operations
  • Facilitated Discussion re: Roles & Responsibilities with Property Management and Services Staff
  • Available Training Support through CSH’s On-Line Training Center 

These activities may be expanded to provide additional training and technical assistance to this supportive housing project and other supportive housing projects experiencing similar operational issues.

Deliverables/Level of Effort
The estimated subcontractor staff commitment for providing the Leadership Team Discussion and Ad Hoc Consultation Support described in the Scope of Work shall be an estimated 32 subcontractor hours, with an estimated 7 staff hours from CSH to provide information re: Resources/Training Support to the onsite staff of the supportive housing project.

If the scope of work is expanded to provide additional training and technical assistance to this supportive housing project and other supportive housing projects, CSH will negotiate with the subcontractor to expand the estimated subcontractor hours to reflect these additional activities.

CSH will work with the subcontractor to finalize the goals and objectives, proposed method and approach, and scope of work for the Leadership Team Discussion and the Ad Hoc Consultation Support to the onsite staff. CSH will work with the subcontractor to maintain regular communication by in-person meetings and phone and email with the two nonprofit organizations.

CSH staff and subcontractor staff will develop and deliver the Leadership Team Discussion, Ad Hoc Consultation Support and Resources/Training Support identified in the scope of work. These activities will be completed during the period from January 2017 to April 2017.

If the scope of work is expanded to provide additional training and technical assistance to this supportive housing project and other supportive housing projects, CSH will negotiate with the subcontractor to expand the estimated timeline.

Next Steps
Please submit a subcontractor proposal to provide the training and technical assistance support identified in the scope of work. If you have additional questions regarding this training and technical assistance assignment, please contact:
Steven Shum, Senior Program Manager
369 Pine Street, Suite 350
San Francisco, CA 94104

Meet the CSH Board: Don Falk

Don Falk is the Chief Executive Officer of the Tenderloin Neighborhood Development Corporation (TNDC)

Why did you join the CSH Board? don_falk_tndc
It is an honor for me personally, and for TNDC, to be represented on the Board of Directors of CSH. Coming from the development world I do not consider myself an expert in homeless services and was not sure that I had a unique perspective to offer. But CSH persuaded me that my skills and view would add value to the board. From a selfish standpoint, being on the Board has also brought me into relationship with some very knowledgeable people from whom I can learn and who can help TNDC.

I’ve been really impressed with the quality of CSH’s staff, a key element to a good experience as a Board member.

What excites you the most about CSH’s work in supportive housing?
CSH is on the cutting—some might say “bleeding”—edge of new knowledge around supportive housing –around the entire country people are innovating and learning, and CSH is the conduit to both receive and distribute that information. Participating in board meetings and talking to CSH staff provides a richness and texture that is tough to convey in e-newsletters.  Being situated to hear and see the work unfold in my position as a Board member is motivating, and a real privilege.

There is a big sweeping thing that could happen here in the U.S. around a sustainable revenue model for supportive housing is gaining momentum. In San Francisco we’ve being piloting it for 10 years, but what CSH is doing is much broader, in the context of many more localities and different partners; CSH is a pioneer in the Pay for Success movement.  All of that is inspiring because I approach this work partly from a non-philanthropy viewpoint – I want to do this work for all the right reasons, of course, but with a financially sustainable, business-oriented model to solve social problems.

Where do you see the supportive housing industry in 10 years?
In my dream world, supportive housing would not be the exception – it would be routinely accepted by people and communities as not merely humane but smart policy. Supportive housing will utilize a readily accessible revenue model where we save money by housing homeless people and then pay for the housing out of the savings.

How has the tight housing market impacted your work as a CDC?
We’re at ground zero of the national affordable housing market crisis here in San Francisco – it has had a profound impact. It’s more than the broader issue of gentrification and displacement, which of course impacts homeless/formerly homeless people. Beyond the literally 10+ million renter households who pay unaffordable rents, vast groups are in jeopardy of being displaced over the next decade from rising values. The character of our neighborhoods and the character of our city are both changing as a result. Moreover, with the cost of development increasing at a seemingly unsustainable pace (including acquisition and construction costs) across the board we are seeing fewer, smaller projects, which makes it more difficult to ameliorate the housing crisis. In San Francisco’s housing market, the broader issues of inequality are playing out in front of our very eyes.

What has your experience been partnering with an FQHC?
Our partnership at Kelly Cullen Community—which CSH supported with a Social Innovation Fund grant—is  a health center co-located at our supportive housing site. It’s a fantastic thing, serving the entire community’s residents. It really is a testimonial to the fundamental link between health and housing; they’re inextricably connected. It is immensely gratifying to be able to walk someone through the building, introduce them to the people living here and see first-hand the impact of the health connection. You can look, see, touch and feel how health and housing are working together.

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


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


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.”



An article authored by CSH Senior Program Manager Steven Shum appears in Summer 2015 edition of the Non-Profit Housing Association of Northern California (NPH) Newsletter.



By Steven Shum, CSH

Taking advantage of health reform, Bay Area communities are integrating healthcare efforts with affordable homes to better serve the most vulnerable individuals. The Corporation for Supportive Housing (CSH) organized May’s Brown Bag on Health and Housing – highlighting new opportunities with Medi-Cal funding for supportive housing targeted to chronically homeless individuals and frequent users of crisis services. CSH trumpeted recent developments with California’s plan to implement the Health Homes option under the Affordable Care Act and the State’s submission of its 1115 Medicaid Waiver. These efforts represent key opportunities for local communities to leverage federal funding for supportive housing.

“We have been working diligently for more than 20 years to ensure steady and reliable funding to create and operate high quality supportive housing,” said Steven Shum, CSH’s Senior Program Manager in Northern CA. “And we’re on the cusp of exciting changes in the health and housing sectors.”

Panelist Preston Burnes, Provider Services Specialist with Health Plan of San Mateo, shared an update of their Community Care Settings Pilot – an innovative partnership targeting housing services and case management support to vulnerable seniors and other adults using health plan funding.

Panelist Margot Antonetty, Interim Director of Housing and Urban Health with the San Francisco Department of Public Health, discussed the City’s long-standing supportive housing efforts for homeless individuals, including 2,100 supportive housing units currently in their portfolio. Their evidence shows that supportive housing efforts have resulted in reduced emergency and inpatient medical costs and improved health outcomes and quality of life for tenants.

To participate in upcoming informational sessions on the State’s plan for Health Homes implementation, please contact:

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

Face-to-Face SIF Convening Offers Cross-Site Sharing after Three Years of Implementation

2014 SIF Face-to-Face 007

SIF Participant Displays Contents of Overdose Prevention Bag during Harm Reduction Discussion

CSH convened its third annual Face-to-Face gathering in Los Angeles this October for sub-grantees of the of the Social Innovation Fund demonstration project focused on high utilizers of healthcare, now entering its fourth year. Continuing the cross-site learning opportunities that have been a key part of the project, representatives from the four sites participating in the initiative – Connecticut; San Francisco, California; Los Angeles, California; and Washtenaw County, Michigan — spent two days at the California Endowment for the Arts engaged in discussion guided largely by the providers who have been implementing SIF on the ground for the past three years. This year’s gathering centered on the theme of sustainability beyond the five-year grant program, with each site presenting a detailed financial sustainability plan for feedback from an expert panel including representatives from HUD, the Technical Assistance Collaboration, Health Management Associates, and the Hilton Foundation.

Other sessions addressed strategies for programmatic sustainability, building on the sites’ collective body of experience and expertise. One of the key emerging lessons of the work on the ground with these high-utilizing cohorts is that the majority of individuals being served have an array of medical, behavioral, and social challenges resulting in a need for support that is both acute and complex. Participants engaged in rich discussions on innovations and best practices in harm reduction, cross-sector coordination, and nontraditional models for engagement with healthcare.

“I really appreciated being in a space where everyone was so focused on shared tasks and challenges.  SIF has been a huge resource for our agency, helping us learn how to add housing support services to our emergency shelter operation.  It was encouraging to hear from colleagues around the country who have successfully implemented on a larger scale many of the measures we have built into our own sustainability plan.” -David Gonzalez-Rice, Housing Support Team Manager at the New London Homeless Hospitality Center in Connecticut

CSH staff also had the opportunity to partner with the Skid Row Housing Trust to have dinner on the garden terrace of a new supportive housing residence for medically vulnerable high-utilizers, the Star Apartments. To learn more, click here.

2014 SIF Face-to-Face 005

SIF Sites Share On-the-Ground Experiences with Harm Reduction and Housing First