Turning Challenges into Opportunities SIF Classic: Developing housing and heath care solutions for vulnerable populations

CSH Social Innovation Fund 5-year national effort to pilot supportive housing linked to coordinated health care for high utilizers of crisis health services in order to: Increase health and housing stability for at least 549 high-need, high-cost individuals with chronic health challenges Develop a replicable model for integrating housing with care management and health services Build evidence of the model’s impact on housing, health, and public costs Design a policy blueprint for linking mainstream housing and health resources/payment systems (Medicaid) to scale models Initiative strategy includes: Strategic Grantmaking: CSH awarded five year grants to 4 organizations in four communities Systems Change and Technical Assistance: CSH is assisting sub grantees to implement and scale models through a national learning network Evaluation: Researchers from NYU’s School’s of Medicine and Education are completing a multi-method evaluation to measure the impact on health and housing stability, use of crisis health services and Medicaid and other public costs With support from the Center for National and Community Service, CSH is currently in year 3 (going into 4) of a 5-year national effort to pilot supportive housing linked to coordinated health care for high utilizers of crisis health services. The goals of this initiative are to: 1. Increase health and housing stability for high-need, high-cost individuals with chronic health challenges 2. Develop a replicable model for integrating housing with care management and health services 3. Build compelling evidence of the model’s impact on housing, health, and public costs and 4. Design a policy blueprint for linking mainstream housing and health resources and payment systems (primarily Medicaid) to scale models The initiative strategy includes a combination of strategic grant making to four implementation sites across the county, one on one technical assistance and peer learning and a rigorous multi site evaluation lead researchers from the NYU School of Medicine and the School of Education. Evaluation includes a Randomized Controlled Trial in 3 of the 4 sites Process evaluation Tenant baseline and follow up surveys Cost/service utilizations through administrative data sets

Adapting Supportive Housing as a Health Care Intervention Data Driven Targeting Assertive Outreach and Housing First Patient Navigation/Health Care Coordination Clinical Partnerships with Health Care Providers

Tenderloin Neighborhood Development Corporation AIDS Connecticut Lead Organization Tenderloin Neighborhood Development Corporation AIDS Connecticut Housing Works, HHCLA, Acencia, OPCC Avalon Housing Target Geography San Francisco, CA Connecticut (statewide) Los Angeles County, CA Washtenaw County/Ann Arbor, MI Number of Individuals 172 160 107 110 Data Driven Approach to Client Identification Analysis of ED/hospitals records & top 200 users of county health plan services Data match between Medicaid and HMIS to identify top 10% highest users Predictive algorithm to identify highest decile of costs of crisis health service use County health plan data analysis to identify highest cost users Outreach and Recruitment In-reach into hospitals and emergency rooms In-reach into hospitals and shelters Hospital-based screening In-reach into emergency rooms and hospitals Housing Model Single-site supportive housing building (with onsite FQHC) Scattered-site and single-site Single-site and scattered-site Scattered-site Primary and Behavioral Health Services City of San Francisco Housing and Urban Health FQHC Five regional partnerships between FQHCs and LMHAs Several FQHCs University of Michigan Hospital and Packard Health Integration of Health and Housing Integrated services team between TNDC and HUH FQHC-based patient navigators/boundary spanners Patient navigators/system coordinators Integrated Housing and Health Care Team

Progress To Date… 91% housing retention rate 600 people housed 47% engaged at hospital or health clinic Engagement Limited access to care General health status indicates severity of need Those w/ MH (9.1/6.1)*, SU and other health problems (9.7/4.4)* had significantly more ER visits Housing instability associated with more ER visits (5+ years = 9.7 vs. >5 = 6.9)* *past year mean At Baseline… Improved access to care Drop in hospitalizations and utilization of urgent medical care Substance use down or constant Participants feeling positive about the program and their lives At 12 months… Significant, observable impact on tenants outcomes