Permanent Supportive Housing Carrie Rheingans, MPH, MSW Washtenaw Health Initiative Senior Program Manager Upper Peninsula Health Strategies May 1, 2017

Permanent Supportive Housing Not a halfway house Not inpatient treatment Supportive Health care supports Peer support / coaching Other social service navigation

Social Services Bradley & Taylor reviewed 74 studies and found these to be most impactful: Permanent supportive housing Nutritional support (Meals on Wheels, WIC) Some case management and outreach programs In 2011, Bud Clark Commons (BCC) opened in Portland, Oregon—a facility designed to provide housing and supportive services for chronically homeless individuals. Those who were covered by Medicaid had average annual health costs of $2,006 prior to taking up residence in the BCC apartments; in the year after moving in, that figure fell by 55 percent, to $899. A similar program that the University of Illinois Hospital leads, in partnership with Chicago's Center for Housing and Health, has seen health costs for residents fall 42 percent. http://www.rwjf.org/en/culture-of-health/2016/08/how_social_spending.html

Frequent Users Systems Engagement (FUSE) Corporation for Supportive Housing-funded randomized controlled trial 4 sites: LA, San Francisco, state of CT, Washtenaw County, MI Washtenaw – housed 161 people, 123 still housed (86% retention) Target population: very low income, diagnosed MH or SUD, one or more chronic physical health condition, chronically homeless, high utilizer or crisis health services (in past 12 months, had either 8 ED visits, or 1+ hospitalizations and 3 ED visits)

https://www.nhchc.org/wp-content/uploads/2011/10/03-frequent-user-initiative-profile-booklet-washtenaw-approved.pdf

Health Indicators (1 year post housing) 60% rate health as fair/poor 1 in 5 experience a medical problem every day in past month Half report difficulty walking or climbing stairs

Access to Health Care Baseline 1 year follow up ED as main source of care: 58% Needed but could not find a dentist: 76% ED as main source of care: 31% Needed but could not find a dentist: 32% NYU is conducting a 3rd party randomized 5-year control study of the SIF FUSE initiative. These preliminary baseline findings look at data over the first 18 months of participation in the program. The evaluation includes administrative data on health care utilization, baseline and one year follow-up participant surveys, and a qualitative analysis of each site completed during annual site visits with in-person interviews with community stakeholders. These findings are preliminary based on data collected from baseline through 18 months for the 101 people enrolled in the Washtenaw FUSE study. Note: These findings may change by the end of the evaluation and are only indicative of trends.

Mental Health and Social Support Baseline 1 year follow up Frequent Loneliness: 48% Feeling Life is Unstable: 57% Frequent Loneliness: 34% Feeling Life is Unstable: 12%

Mental Health and Social Support Baseline 1 year follow up Feeling Stable About One’s Life: 30% Life is Organized: 24% Feeling Stable About One’s Life: 61% Life is Organized: 75%

Client Satisfaction Nearly all clients reported that the program met all or most needs, and that they would recommend the program to friends. High levels of satisfaction were reported with: Ease contacting social worker Choice of when to see social worker Choice over whether or not to take meds Proximity to shopping, public transport, etc. Independence in daily life Condition and affordability of the apartment

Cost Impact Statistically significant savings and reduced hospitalizations were found with the highest cost individuals Estimated Cost impacts varied with the level of pre- period costs (pre-period is the year prior to randomization) Across all sites, both treatment and control groups experienced substantial declines in utilization and cost in the 18 months following randomization. For most measures of hospital use and health care costs, reductions were greater among those assigned to the treatment than control group. BUT, only in San Francisco and only in regard to hospitalizations did NYU find statistically significant impacts.

Center for Healthcare Research &Transformation Carrie Rheingans, MPH, MSW 2929 Plymouth Road Suite 245 Ann Arbor, MI 48105 (734) 998-7567 Website: www.chrt.org Email: crheinga@umich.edu Twitter: @crheinga