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

2. 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

3. 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

4. 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

5. 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