The Source for Housing Solutions Supportive Housing = Health Care May 3, 2016 Indiana Primary Health Care Association Conference

Lori Phillips-Steele Director, CSH Indiana Jane Bilger Senior Program Manager, CSH National Consulting Team

About CSH Improve lives of vulnerable people Maximize public resources Build strong, healthy communities Advancing housing solutions that:

GOALS: Foster and expand Health Center collaboration with other health system stakeholders, and supportive housing Improve healthcare outcomes for extremely low-income individuals who frequently use crisis systems, have housing instability, and lack a connection to primary and preventive care services. Webinar Series Direct Technical Assistance Online & In-Person Trainings Peer to Peer networks Resources PARTNERS: Deep collaboration with Also partnering with: NACHC CHPS HRSA BPHC CSH HRSA Frequent User T/TA

Ice Breaker: Acronyms

What is Supportive Housing? 6 Permanent, affordable, independent, tenant centered, flexible, voluntary

Supportive Housing is the Solution Supportive housing combines affordable housing with services that help people who face the most complex challenges to live with stability, autonomy and dignity.

Who Lives in Supportive Housing? Housing Supportive Services

CSH Dimensions of Quality Supportive Housing

Single or Scattered Site  Will the Units Be Located in One Building or Scattered Throughout Multiple Properties or Buildings?  Will the Units be Owned or Leased?

Supportive Housing = Health Care

The Source for Housing Solutions Health and Housing Partnerships

Frequent User System Engagement Communities spend billions of dollars on services that bounce vulnerable people between crisis services. CSH's FUSE model helps break that cycle while increasing housing stability and reducing multiple crisis service use. Data-Driven Problem-Solving Policy and Systems Reform Targeted Housing and Services Cross systems data match Track Implementation Track Implementation Measure outcomes, impact and cost effectiveness Convene multi- sector working group Troubleshoot housing placement and retention barriers Enlist policymakers to bring FUSE to scale Create supportive housing, develop recruitment process Recruit and place clients into housing, stabilize with services Expand model and house additional clients

University of Southern Indiana (USI) Study of Supportive Housing  IHCDA commissioned the University of Southern Indiana (USI) to study supportive housing in Evansville, IN  Mix of scattered site and single site  Mix of family and individuals  USI Study demonstrates effectiveness in the following areas  Improving residents’ lives  Generating significant cost savings to public systems  Benefitting the local community

USI Study – Cost Savings

USI Study – Improved Quality of Life  Reported Quality of Life Post-entry  81% of tenants have lived in their IPSHI apartment for over one year  69% reported increased school attendance for their children  67% reported higher level of involvement in their children’s education  63% reported better relationships with family members  53% increase in community involvement  58% reported that conditions of their neighborhood as better

Health Outcomes and Saving $$  SF study found 5-year survival rates of 81% for PLWAs in supportive housing compared with 67% who remained homeless  Chicago study found 55% survival for PLWAs in supportive housing compared with 35% of control group, and lower viral loads among housed group  Seattle study found 30% reduction in alcohol use among chronic alcohol users in SH  Denver study found 50% of tenants improved health status and 43% had improved MH  Direct Access to Housing in San Francisco found that supportive housing reduced nursing home costs by $24,000.  Chicago – Permanent supportive housing saved almost $25,000 per person, per year  Downtown Emergency Shelter Center in Seattle showed 41 percent in Medicaid savings by reducing ER visits and hospital inpatient stays.  Portland, Maine - Medicaid costs were reduced by almost $6,000 Health Outcomes Cost Savings

CSH Guidance Document Make the Case Make it Happen Make it WorkMake it Last

Framework for Building Partnershps Understand the value of health and housing partnerships Gain hands-on experience preparing for partnership Practice building a partnership plan Learn strategies for making a partnership last

What’s in it for Health Centers? Make the Case

What’s in it for Supportive Housing Providers? Make the Case

The Right Structure Referrals Care Coordination Co-Location Full Service Integration Make it Work

Where to Look Your existing networks Keep it local Client overlap Complementary services Identify Potential Partners Make it Happen Find a local health center: findahealthcenter.hrsa.gov Find a local housing provider: portal.hud.gov/hudportal/HUD?src=/states

Focus on Indiana Partnerships  What is the motivation?  What are the barriers?  What are the next steps?

Community: Evansville  Project Goals/ Objectives:  Identify high cost and most vulnerable across multiple systems  Create a more efficient and humane system to address the needs of the target population  Name & Role(s) of Project Partners  Community Mental Health Center  St Mary’s Medical Center  ECHO Community Health, Inc.  Vanderburgh Health Department  Initial Target Systems:  Coordinated Entry  Coordinated Health Needs Assessment  Vanderburgh Mental Health and Drug Court  Homeless Medical Respite  Future Initiatives:  New PSH development  On-site Medical Clinic

Community: FUSE South Bend  Project Goals/ Objectives:  Identify high cost and most vulnerable across multiple systems  Provide PSH to stabilize  Coordinate continuum of care services to improve outcomes and reduce costs  Name & Role(s) of Project Partners  City of South Bend  United Way, South Bend Heritage Foundation  Memorial Hospital  Oaklawn and Michiana Health Network  Indiana Health Center  Neighborhood Development Associates, Bradley Management  Targeted Population  Population Defined: chronically homeless frequent users of crisis systems  High incidences of mental illness and/or substance addictions  New 32 units of PSH

Community: Penn Place in Indianapolis  Project Goals/ Objectives:  Reduce housing and service barriers for chronically homeless & frequent users of crisis care systems  Build partner capacity for quality/low barrier PSH using Housing First/harm reduction approach  Project Start Date: December 2015  Average Timeframe Program Enrollment & Move-in: 1 month  Name & Role(s) of Project Partners  Eskenazi Health & Midtown Mental Health  Horizon House  BWI, LLC & Indianapolis Housing Agency  Targeted Population  Population Defined: chronically homeless frequent users of ERs, ambulances, criminal justice  # Targeted: 42  # Housed to-date: 42  Other Key Partners  CSH  IUPUI – School Public Health

Community: Penn Place in Indianapolis  Outcomes Tracking:  1 year pre and post activity and costs  Health outcomes related to use of community health resources  Reduced barriers to accessing housing  Housing retention  Strategies:  Data sharing MOU to identify frequent users and highest vulnerability  Flexibility in tenant screening criteria  Targeted Housing First Training across service and property management staff  Additional Services:  Substance use and mental health  Employment and empowerment  Peer engagement  Other: library and other health resources

IPHCA May CSH Resources CSH FUSE Guide CSH Health and Housing Partnership Guide Housing-Partnerships-Guide.pdf Housing-Partnerships-Guide.pdf CSH Supportive Housing Training Center b_page_id=-67&tab_id= CSH HRSA Technical Assistance and Training

IPHCA May CSH Contacts Lori Phillips Steele Jane Bilger