Dimensions of Quality Supportive Housing Guidebook

In creating and sharing the CSH Dimensions of Quality Supportive Housing, CSH strives to:

  • Build the capacity of the supportive and affordable housing industries to create and operate highquality,
    effective, and sustainable supportive housing units
  • Encourage the investment of adequate resources, especially from public systems, to support that
  • Ensure that existing resources for supportive housing are being used efficiently and effectively,
    and support the allocation of new resources
  • Create better outcomes for supportive housing tenants, especially those with multiple barriers to
    housing stability

The NYC FUSE Program Evaluation Snapshot

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

Join FUSE Learning Community

Communities waste billions on uncoordinated and expensive service responses as people without housing frequently cycle between shelters, hospitals, jails, and the streets. Your community can end this costly revolving door by housing and helping those in need, and improving overall quality of life. How? By being selected to participate in the new, one-time only FUSE (Frequent Users Systems Engagement) Learning Community from CSH.

CSH FUSE is a proven, effective model identifying your frequent users of jails, shelters, hospitals and/or other crisis public services and matching them with supportive housing, an evidence-based solution that leads to better health and other good outcomes for people homeless and disabled. Tenants are provided very affordable housing with support services, all aimed at promoting stability that significantly reduces returns to jail and homelessness, and a reliance on emergency health services.

The FUSE supportive housing framework has been implemented in more than 30 communities across the country and is currently being planned in another 15.

In addition to monthly office hours with CSH FUSE experts, the Learning Community will offer five virtual trainings held between September 2018 to January 2019. Topics covered by the virtual trainings will include: FUSE stakeholder engagement, cross systems data matching/data driven targeting, supportive housing resource creation and scaling, and more. Hands-on guest speakers from FUSE communities will be featured whenever possible. Trainings will be interactive and offer opportunities for peer discussion among communities.

CSH anticipates selecting 15-20 communities to participate in the Learning Community. If your community is interested in applying, please click this link and complete our survey by Thursday, September 6, 2018, 7pm CT. Successful applicants will be notified and announced by CSH soon thereafter. Please contact fuse@csh.org with any questions.

CSH Awarded Grants Totaling $250,000 from United Hospital Fund and Altman Foundation

CSH has received a $125,000 grant from the United Hospital Fund and another $125,000 grant from the Altman Foundation to increase the integration of health and housing partnerships in New York by scaling The Bronx Frequent Users of Hospital Systems (Bronx FUSE) Initiative, which identifies and helps very vulnerable people within the healthcare systems who are in need of housing. FUSE is a CSH signature initiative demonstrating how communities can identify and engage super utilizers of public systems and place them into supportive housing to break the cycle of repeated use of costly crisis health services, shelters, and the criminal justice system. Specifically, the recent United Hospital Fund and Altman Foundation awards will build on the successes we have seen to date through our local FUSE projects, with a deeper emphasis on replicability within other communities, and with a more intense focus on a broader range of high-cost Medicaid beneficiaries. Ultimately, through the new funding, CSH will work to develop a Roadmap to establish and replicate partnerships between health plans and housing providers, and execute data sharing agreements in order to better understand the needs of their shared clients, especially super utilizers. Additionally, the proposed project will offer CSH the opportunity to hone an enhanced supportive housing model specifically catered to the needs of super utilizers of crisis systems, who may require a greater level of care to maintain housing stability and improved health outcomes.   CSH is currently working with key stakeholders, including health plans serving members in the Bronx, to collect and analyze data on the highest-need homeless Medicaid recipients in the Borough and to prioritize the most vulnerable for a housing intervention. As they become available, CSH intends to disseminate our findings to the broader supportive housing field, healthcare sector and government entities.

Learn much more about the Bronx Frequent Users of Hospital Systems (Bronx FUSE) Initiative by clicking here.

CSH-SIF Webinar Forum Announced

Through the CSH Social Innovation Fund Initiative (CSH-SIF) nonprofits in four communities are implementing an enhanced supportive housing model. 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.

Join us for a webinar on CSH-SIF Evaluation results on Thursday, March 29, at 1pm ET. You can register for the webinar by clicking here.

Purpose of the Webinar

This webinar will present the results of the evaluation.

Learning Objectives for the Webinar

  • Know the results of the CSH-SIF five-year RCT Evaluation conducted by researchers from New York University.
  • Utilize lessons from data-driven targeting, healthcare-focused supportive services, and other design elements incorporated in the CSH-SIF program.
  • Understand what outcomes and potential cost avoidance to expect when funding or delivering supportive housing for high utilizers of healthcare.

Agenda for the Webinar

CSH-SIF Eval & Overview of Service Models Sarah Gallagher 15 min
Service Model by Site 1 or 2 Local CSH-SIF Sites 15 min
NYU Findings Beth Weitzman 25 min
Facilitated Q&A Sarah Gallagher (Facilitator) 5 min

Avalon Housing, CSH and NYU to host FUSE Social Innovation Fund key findings briefing

Ann Arbor, Michigan – February 5, 2018- Spurred by investments from the Corporation for National and Community Service, the Corporation for Supportive Housing (CSH) has been leading a five-year national demonstration to create and evaluate supportive housing as a solution to addressing the needs of our health care system’s highest-need, highest-cost patients who are experiencing homelessness. Ann Arbor-based non-profit Avalon Housing was one of the four grantees who led this demonstration known locally as FUSE (Frequent Users Systems Engagement). During the five-year project, Avalon worked closely with numerous service providers, including the University of Michigan Health System, St. Joseph Mercy Health System, Packard Health, Community Mental Health, the Shelter Association and the Ann Arbor Housing Commission, among others.

This demonstration was one of the first initiatives to investigate whether supportive housing  has a significant impact on health care utilization and costs among homeless adults who are high utilizers of the health care system. The project was independently evaluated by an interdisciplinary team of researchers from New York University, led by Principal Investigator Beth C. Weitzman, PhD. This evaluation is the first randomized controlled trial (RCT) evaluation of a national supportive housing demonstration of this scale. The evaluation included 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.

Using data matching across multiple systems, FUSE targeted 150 individuals who met threshold criteria for frequent utilization of crisis systems, including homelessness or housing instability, low income, behavioral health conditions, chronic physical health conditions and frequent emergency room utilization and/or hospitalizations. Through housing navigation, intensive case management and care coordination for primary and behavioral health services, the FUSE project aimed to demonstrate an increase in housing stability for homeless individuals. The project also sought to demonstrate a reduction in the use of emergency systems, improved health outcomes for medically vulnerable individuals and cost savings across multiple systems.

The New York University RCT evaluation concludes that supportive housing can reduce utilization of shelters and costly health care in some populations and can be an important care coordination approach for people with complex health conditions who also experience homelessness. These reductions can substantially offset program costs. This is the first randomized control evaluation of a national supportive housing demonstration of this scale.

Says Aubrey Patiño, Executive Director of Avalon, “FUSE has made an incredible impact on our community at large, paving the way for housing and healthcare partnerships across the state. At Avalon, we know that housing is fundamental to people’s health and wellbeing. We see that every day. FUSE allowed us to build the evidence base for this intervention while leveraging systems change that permanently shifted our community’s approach to effectively serving this population. The end result is that people cycling out of homelessness and crisis systems are stably housed, have access to the health care they need and are living with dignity.  We are also more effectively using our community’s resources, and supportive housing now serves as a platform for recovery.”

On Friday February 16, 2018 from 1:00-3:00 pm at the St. Joseph Mercy Education Center, 5305 Elliott Drive, Ypsilanti, the CSH and NYU evaluation team members, including Senior Program Manager Lauren Fulton from CSH, Beth C. Weitzman, Ph.D., Professor of Health and Public Policy, NYU Steinhardt, and Carolyn Berry, PhD, Associate Professor, Department of Population Health, New York University School of Medicine, will discuss key evaluation findings from Avalon’s FUSE initiative, in addition to evaluation findings across the other three SIF sites, including Los Angeles, San Francisco, and the State of Connecticut.


Avalon Housing, Inc. is a non-profit organization created in 1992 as a long-term solution to homelessness. Avalon develops, owns and manages supportive housing for over 750 of Washtenaw County’s lowest-income residents, including 200 children. We serve people who have been chronically homeless and who have behavioral and physical health challenges, including mental illness and substance use disorders. To learn more, visit avalonhousing.org.

Contact: Marcia Luke-van Dijk
(734) 904-4822

CSH has been the national leader in supportive housing for over 25 years. We have worked in 48 states to help create stable, permanent homes for individuals and families. This housing has transformed the lives of over 200,000 people who once lived in abject poverty, on our streets or in institutions. A nonprofit Community Development Financial Institution (CDFI), CSH has earned a reputation as a highly effective, financially stable organization with strong partnerships across government, community organizations, foundations, and financial institutions. Our loans and grants totaling over $700 MM have been instrumental in developing supportive housing in every corner of the country. Through our resources and knowledge, CSH is advancing innovative solutions like CSH-SIF and FUSE that use housing as a platform for services to improve lives, maximize public resources, build healthy communities and break the cycle of intergenerational poverty. Visit us at csh.org to learn more.

Contact: Robert Friant
212-986-2966, x245

LA Health & Housing Symposium Part II

Last October, CSH convened the first of three Los Angeles Health and Housing Symposiums at the California Community Foundation’s Palevsky Center.

The second – Part II – was held today in LA at that same venue, where CSH highlighted health and housing organizations that are successfully coordinating care for homeless Medi-Cal beneficiaries.

A packed house learned from national and local experts how healthcare institutions are collaborating with federally qualified health centers (FQHCs), homeless services providers, and supportive housing providers to serve beneficiaries experiencing homelessness.

Several panelists and presenters discussed the nuts and bolts of deepening community partnerships, clarifying partner roles, and expanding and sustaining integrated services for homeless beneficiaries in today’s fast-moving environment.

Did you miss the first Symposium – Part I ? Materials from that forum are listed below:

CSH-SIF Evaluation Summary Released

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




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.

CSH-SIF Evaluation Summary

CSH-SIF Evaluation One Pager

LA Health & Housing Symposium

CSH convened the first of three Los Angeles Health and Housing Symposium on October 23, 2017 at  the California Community Foundation. CSH brought together over 50 health and housing organizations involved with coordinated care for homeless Medi-Cal beneficiaries to collaborate on new Los Angeles County initiatives (Measure H, Whole Person Care LA, Drug Medi-Cal Organized Delivery System).

The Symposium was well attended – the room was packed with over 100 healthcare and housing leaders from across the County, including 48% from the healthcare sector (i.e., MCOs, hospitals, FQHCs, and the Los Angeles County Health Agency) and 52% from homeless services and supportive housing (i.e., homeless services providers, supportive housing developers, and the Los Angeles Homeless Services Authority).

This first of the three-part symposia focused on level-setting, with the goal to increase collective understanding of how healthcare institutions can collaborate with homeless services providers to access Measure H (County ¼-cent sales tax), Whole Person Care LA (1115 waiver), and Drug Medi-Cal Organized Delivery System (1115 waiver) networks to better serve their members experiencing homelessness.

The opening discussion was dedicated to sharing outcomes and best practices in collaboration from the Los Angeles 10th Decile Project (2011-17), which created robust health and housing collaborations to house and case manage high-acuity patients. Presenters shared two diagrams that map the new set of resources coming into Los Angeles County – to set the table for the second hour presentations on Measure H, Whole Person Care, Drug Medi-Cal and Coordinated Entry as the gateway for services and housing.


In the third hour, participants engaged in a dynamic give-and-take that focused in each Service Planning Area (SPA), and reported next steps, which include: strengthening communication and collaboration with SPAs; conducting inventories of service gaps, exploring co-location, building more regional resources; and standardizing high-utilizer projects.

The main takeaways from the first Symposium were:

  • very strong demand for information and education around the relationship between the new health and housing funding streams, and people feel (rightly) that things are moving very quickly; CSH can play a role in education and communication across funding streams
  • strong desire in 6 of the 8 SPAs to move forward on integrating health and housing: SPAs 2, 4, 5 are further along while SPAs 3, 6, 8 are just beginning (see next steps above)
  • interest from CSH partner hospitals and MCO partners in partnering, but others need to be engaged
  • workforce issues like shortages and burn-out are a big concern as H and WPC ramps up
  • existing gaps in system: warm handoffs still difficult, inability to make real-time connections to PCPs, lack of access to specialty care, lack of 24/7 services, funding for highest-acuity/delay in HHP, lack of data sharing agreements between hospitals and HMIS

The ultimate goals of the symposia are to foster and deepen partnerships between the healthcare and housing sectors and to inspire and inform long-term commitments to expanding integrated services for homeless frequent users by moving to shared problem-solving across sectors.

The next Symposium will take place on January 23, 2017 at the California Community Foundation, and will focus on how to create, structure, and problem-solve together by mining existing partnerships between homeless services providers, FQHCs, and hospitals, and between county health and housing systems and managed care organizations.

The third Symposium in April will focus on co-occurring disorders, workforce, and data sharing.


Use the links below to access Symposium documents:

  • 2 Maps: Full Array of Integrated Services in SH and Pathways for Hospital Frequent Users


  • Full meeting slide deck


  • 10th Decile Project Impact Brief


Housing the First 100

The Orlando Housing First initiative, “Housing the First 100”, is a collaborative undertaking in the City of Orlando and tri-county area. The project connects high cost, high need, homeless frequent users to housing and services. Read our latest Housing and Healthcare profile.