FUSE Frequent Users System Engagement Hunter Snellings, Virginia Housing Alliance

What is FUSE? A framework for creating and targeting supportive housing. It combines data-driven targeting, stakeholder engagement, and quality supportive housing for the most vulnerable frequent users of public systems. A signature initiative of the Corporation for Supportive Housing (CSH), created in 2007 and replicated in nearly 30 communities around the US, including Fredericksburg and Richmond Answer to the question, “Can permanent supportive housing reduce the cost and frequency with which public institutions serve the most vulnerable in our community?” Aimed at improving life outcomes for tenants, more efficiently utilizing public resources, and identifying cost avoidance measures in crisis systems like jails, hospitals, and shelters.

The Institutional Circuit “Murray Barr was a bear of a man, an ex-marine, six feet tall and heavyset, and when he fell down – which he did nearly every day – it could take two to three grown men to pick him up. He had straight black hair and olive skin. On the street, they called him Smokey. He was missing most of his teeth. He had a wonderful smile. People loved Murray.” “I’ve been a police officer for fifteen years,” said Steve Johns of the Reno Police Department. “I’ve picked up Murray my whole career. Literally.” “Often, he was too intoxicated for the drunk tank at the jail, and he’d get sent to the emergency room at either Saint Mary’s or Washoe Medical Center. Marla Johns, who was a social worker in the emergency room at Saint Mary’s, saw him several times a week. ‘The ambulance would bring him in. We would sober him up, so he would be sober enough to go to jail. And we should call the police to pick him up. In fact, that’s how I met my husband.’ Marla Johns is married to Steve Johns.”

Million Dollar Murray They found that if you totaled up all of his hospital bills for the ten years that he had been on the streets – as well as substance- abuse treatment costs, doctor’s fees, and other expenses – “It cost us one million dollars not to do something about Murray,” - Officer O’Bryan

Typical FUSE Client FUSE clients cycle between systems, with little opportunity for engagement in each. Outcomes for this client are poor, and typically they have many issues stemming from mental illness, substance use, and chronic health conditions Without housing, they cannot access or make effective use of treatment and supportive services (“But for” rule of thumb) Supportive housing can break cycle of homelessness and incarceration among individuals who are known “frequent flyers” of jail and shelter

Breaking the Institutional Circuit Million Dollar Murray and the thousands of other chronically homeless individuals like him currently caught in the institutional circuit: Indicate the complex, co-occurring social, health, and behavioral health problems that plague so many experiencing homelessness Reflect the failures of mainstream systems of care to adequately address needs Demand more comprehensive, targeted intervention with coordinated system response

Breaking the Institutional Circuit: The FUSE Approach Cross-system, data-driven identification of target population Assertive targeting, outreach, in-reach, and recruitment Permanent Supportive Housing Enhanced service coordination and care management Measure reductions in use and cost effectiveness

CSH’s FUSE Blueprint Data-Driven Problem- Solving Cross-system data match to identify frequent users Track implementation progress Measure outcomes/impact and cost-effectiveness Policy and Systems Reform Convene interagency and multi-sector working group Troubleshoot barriers to housing placement and retention Enlist policymakers to bring FUSE to scale Targeted Housing and Services Create supportive housing and develop assertive recruitment process Recruit and place clients into housing, and stabilize with services Expand model and house additional clients

Permanent Supportive Housing (PSH) FACT: At least 80 percent of tenants in permanent supportive housing are stably housed and do not return to homelessness. Permanently ends chronic homelessness and closes the costly revolving institutional door for people with multiple, severe mental and physical conditions – providing a secure home and the ongoing supports that seriously ill people need. Prioritized for the hardest to serve, most vulnerable, chronically homeless Affordable – ideally household pays no more than 30% of its income toward rent Permanent – no limits on length of tenancy

Permanent Supportive Housing Voluntary Services – Case manager proactively engages members of the tenant household in a flexible and comprehensive array of supportive services, without requiring participation in services as a condition of ongoing tenancy Connects with clinicians and community-based experts to address issues resulting from substance abuse, mental health and other crises, with a focus on fostering housing stability Supports tenants in connecting with community-based resources and activities, interacting with diverse individuals including those without disabilities, and building strong social support networks

PSH Impact on Costs

FUSE Results New York, NY, FUSE Approximately 200 tenants housed between 2008 and 2010 using city and state-funded support services paired with Section 8 vouchers. 2-year evaluation by Columbia University found 40% reduction in jail days, 90% reduction in shelter days, and 50% fewer psychiatric inpatient hospitalizations – a $15k savings per year per tenant. Established regular data matching between corrections and homeless system; increased access of community agencies to shelters to engage clients.

FUSE Results Mecklenburg County, NC, MeckFUSE Community provider has housed 45 participants using county mental health jail diversion funds. Two-year results: 90% retention rate and reductions in jail use. 52% report improved family relationships. Evaluation is in process. Collaboration between Mecklenburg Criminal Justice Services, Mecklenburg County Sheriff’s Office, Mecklenburg County Community Support Services, Behavioral Health, Housing Authority, Shelters, Urban Ministry Center, UNC Charlotte.

FUSE Phases Project Planning Establish roles and responsibilities Develop and finalize MOU/Data sharing agreement Establish evaluation goals/process Conduct data match(es) Phase 1: Pre Move-In Locate, engage, and screen potential clients Phase 2: Move-In Place program clients into supportive housing units and assess to determine care/supportive service needs Phase 3: Post Move-In Develop client service plans and provide each with housing-based case management Evaluate program effectiveness and client experience Maintain ongoing case conferencing to discuss occupancy/vacancy information, client well-being, participation in structured activities, health status, crises intervention, etc.

FUSE in Virginia Richmond FUSE – Reentry supportive housing program for individuals with chronic medical or behavioral health challenges leaving jails or prisons Developed in partnership with CSH in The City’s Criminal Justice Services Division received HUD funds to provide PSH for 15 homeless offenders off of the court’s mental health docket. Beginning in October 2015, the City’s Department of Justice and VSH began the process to house 12 individuals. Partners: Department of Justice Services, Department of Social Services, Sheriff’s Office, Homeward, VSH, and RBHA. Results: VSH currently has seven participants in housing and three in the process with the goal of serving 12 by the end of the first year. Service Connections: Units prioritized and matched by the GRCoC’s Singles Housing Team by the results of interview and assessment gauging vulnerability, chronicity, and medical needs. Participants are provided ongoing stabilization support and 24- hour crisis response.

FUSE in Virginia FredFUSE – Supportive housing program for chronically homeless individuals with histories of frequent incarceration and healthcare system involvement Developed in partnership with CSH and VHA. Currently in the initial planning phases, VHA is working with the George Washington Regional Commission to develop a MOU that will guide the pilot implementation later in Micah Ecumenical Ministries will house and provide services for up to 10 of the region’s justice-involved chronically homeless individuals. The University of Mary Washington will evaluate the program’s effectiveness over a two-year period following move-in. Partners: Regional stakeholder collaborative, GWRC, Micah Ecumenical Ministries, Mary Washington Healthcare, Rappahannock Regional Jail, Fredericksburg Police Department, Rappahannock Area Community Services Board. Service Connections: Initial data match; assertive engagement process; ongoing stabilization services and program evaluation.

Questions? Hunter Snellings Director of Programs Virginia Housing Alliance P: E: vahousingalliance.org