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Addressing Homelessness Among People With Justice Involvement: Los Angeles County’s Just in Reach Pay for Success Demonstration Project

Article published in Cityscape.

Stephanie Mercier at CSH and Sarah B. Hunter and RAND Corporation co-authored an article in Cityscape, a journal covering research on housing and community development, published by the Office of Policy Development and Research (PD&R) of the U.S. Department of Housing and Urban Development. This article presents an overview of the execution and results of the inaugural Pay for Success (PFS) initiative with Los Angeles County. In 2017, the county embarked on a program utilizing the PFS framework that offered housing and supportive services as a jail alternative for those with a history of homelessness and persistent health ailments. This innovative model established a financing mechanism of two key investors, paired with funding collaborators, an intermediary team overseeing implementation and outcome benchmarks that included CSH, and an independent evaluator to assess the program’s overall impact. The county collaborated with providers of housing rental assistance, service navigation, and intensive case management to administer the program. Participants were tracked over two years after enrollment and placement into supportive housing. Concurrently, the team followed the trends among a comparative cohort of similar individuals who were not program beneficiaries. This article summarizes how the program operated and was financed, what the findings were, and the broader evaluative implications. Its purpose is to spotlight how Los Angeles County applied the PFS approach to furnish supportive housing for those entangled with the justice system.

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FUSE 10-Year Follow Up Report: Initial Findings

The New York City Frequent Users System Engagement program (FUSE) was part of the CSH’s Returning Home Initiative, a multi-year effort of public, inter-agency collaboration and investment that provided supportive housing for people cycling between incarceration and homelessness. NYC FUSE targeted persons with recurring homelessness and incarceration, most of whom challenged also by health, mental health, and/or substance use issues.

Columbia University researchers evaluated FUSE by comparing program participants with a closely matched comparison group of “frequent users.” This evaluation found that supportive housing significantly reduced participants’ (re)admissions to and time spent in jail and homeless shelters and their use of crisis healthcare services. These reductions resulted in significantly lower costs for publicly supported services, offsetting housing and other program costs. Results have inspired jurisdictions throughout the US to launch similar efforts.

Now, 10 years later, the FUSE Long Term Study presents a unique opportunity to examine stable housing as a critical component of successful community reentry, not simply in the short term but over people’s lives.


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FUSE: Local Perspective and Statewide Impact in Montana

Often the Frequent Users Systems Engagement (FUSE) approach is developed in a single community for a single program. In Montana, FUSE developed statewide across seven different communities. While these communities have much in common, each has its own diverse set of characteristics from geography and population, to partnerships and capacity. This case study offers an interesting perspective on the statewide approach to FUSE in Montana.

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New Initiative in Kansas City Successfully Reduces Hospital Interactions and Promotes Housing Stability for Formerly Homeless Individuals

In 2017 Truman Medical Centers Behavioral Health, now known as University Health Behavioral Health, or UHBH, launched the 500 in Five campaign that committed to developing and/or securing 500 units of
housing over five years.

In partnership with University Health Behavioral Health (UHBH) staff, the Corporation for Supportive Housing (CSH) and University of Missouri – Kansas City (UMKC) Department of Psychology reviewed health care utilization, behavioral health services, and court data on 80 supportive housing tenants housed through the 500 in Five housing initiative launched
by UHBH in late 2017. The study group included people housed by UHBH between November 1, 2017, and February 25, 2020, a timeframe that allowed one year after housing elapses for each person before initiating a comprehensive records review of University Health (UH) health care utilization among these individuals in April 2021. The purpose of the analysis was to see what effect if any, housing had on tenants’/patients’ utilization of UH health care services and UHBH outpatient services.

The data presented in this report suggest that enrollment in UHBH’s behavioral health services combined with subsidized housing had a significant effect on how patients utilized health care at the hospital. Looking at utilization by subtype group yielded several statistically significant results that demonstrated changes in health utilization from pre-housing to post-housing. Most notably, there was a steep decline in both the number of psychiatric inpatient events (down to less than one on average per person from nearly five in the pre-period for those psychiatrically hospitalized in the year prior to housing) and the cost of those hospitalizations (decreased by 98%).

This result is consistent with several studies of permanent supportive housing that show significant decreases in psychiatric emergency department visits and psychiatric inpatient hospitalizations.

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Health and Housing: Introduction to Cross-Sector Collaboration (via NASHP)

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This article was authored by Marcella Maguire, Allie Atkeson, and Sandra Wilkniss. Dr. Maguire is Director, Health Systems Integration at CSH. Below is an excerpt and link to the article.

For the past decade or more, state leaders have worked across health and housing sectors to strengthen comprehensive services for individuals experiencing homelessness and housing instability. However, challenges remain for successful, person-centered coordination, cross-agency work and implementation. A significant restricting factor that limits coordination is the fragmentation of the health and housing sectors, with persons or households with multiple needs having to navigate multiple systems to address these needs.

The COVID-19 pandemic and related economic and social crises have further exacerbated long-standing needs for coordinated health and housing services. Structural and institutional racism has created segregated communities and limited access to resources, furthering the need to center equity in states’ health and housing work. Click here to access the entire article.

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Strategies for Providing Health Care for Frequent Users in Rural Communities

Frequent Users are defined as individuals with complex needs that have significant interaction with crisis services such as emergency rooms, ambulance transport and substance use detox services. This webinar outlines strategies for meeting the complex needs of this population in rural areas.

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Finding Deeper Resources: Health and Housing Partnerships Create New Funding Mechanisms for Supportive Housing

This webinar and facilitated discussion of expert panelists outlines the benefits of investing in supportive housing and the role of Medicaid for new funding streams for supportive services to keep people successfully housed.

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Who Are Frequent Users? A Closer Look at Definitions Used by Communities

“Frequent Users” are often defined as individuals with complex needs that have significant interaction with crisis services such as shelters, emergency rooms, ambulance transport and substance use detox services. This webinar takes a closer look at the various definitions of “Frequent Users” across the country and highlights successful programmatic approaches to support these populations.

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Data Sharing between Health Centers and Housing Providers: Using Data to Target, Refer, and Coordinate Care for Frequent User Patients

This national webinar and facilitated discussion provides an overview of the benefits of data sharing between the sectors of health and housing. This cross-sector collaboration is especially beneficial for identifying and meeting the needs of “frequent users,” those patients with the most complex needs cycling between high-cost emergency services such as emergency rooms, detox services, ambulance services and hospitalizations.