1. Ending the Cycle of Homelessness and Incarceration Through Supportive Housing June 7, 2012 Andy McMahon, CSH

2. CSH helps communities create permanent housing with services to prevent and end homelessness. Corporation for Supportive Housing

3. Goal of CSH and NACo Partnership To foster and strengthen efforts to end the cycle of homelessness and incarceration in county jails through placement in affordable housing with the necessary supports to stabilize and thrive in the community

4. The Problem Thousands of people with chronic health conditions cycle in and out of county jail and other (often county-funded) crisis systems of care and homelessness - at great public expense and with limited positive human outcomes.

5. The Intersection of Systems and Issues County Jail Hospitals/ Emergency Rooms Homelessness

6. 6 High Use of Public Services with Poor Outcomes Billings’ (2006) analysis of NYC Medicaid claims data found that: –20% of adult disabled patients subject to mandatory managed care account for 73% of costs –3% of patients accounting for 30% of all costs for adult disabled patients

7. 7 A Small Number of Very High Risk Homeless Persons At risk for extensive need of health and justice system services The most expensive 10% of homeless persons have average monthly costs $6,529, regardless of whether they are homeless or housed Average Monthly Costs in All Months by Decile for Homeless GR Recipients Source: 2,907 homeless GR recipients in LA County with DHS ER or inpatient records Deciles based on costs in all months whether homeless or housed The greatest cost savings can be achieved by prioritizing high-risk individuals Source: Economic Roundtable, 2011

8. The Solution & FUSE Premise Identifying people who cycle between homelessness and incarceration and placing these people in supportive housing will improve life outcomes for the tenants, more efficiently utilize public resources, and likely create cost avoidance in crisis systems like jails, hospitals and shelter.

9. What is Supportive Housing? Supportive housing is a cost- effective combination of permanent, affordable housing with services that help people live more stable, productive lives.

10. Supportive Housing Is… Permanent affordable housing with combined supports for independent living  Housing is permanent, meaning each tenant may stay as long as he or she pays rent and complies with terms of lease or rental agreement  Housing is affordable, meaning each tenant pays no more than 30% to 50% of household income  Tenants have access to an array of support services that are intended to support housing stability, recovery and resiliency, but participation in support services is not a requirement for tenancy

11. Supportive Housing Scattered-site: Use Section 8 Housing Choice Vouchers (or State rental assistance programs) + mobile case management services Congregate: Unit set-asides in new supportive housing buildings or existing supportive housing with turnover Providers link tenants to accessible mental health, substance addiction, employment, and other support services Providers should be trained in Motivational Interviewing, navigating criminal justice system, harm reduction, recognizing “symptoms” of incarceration, health care coordination

12. FUSE Benefits By providing frequent systems users with stable, supportive housing the following outcomes can occur: –Decreased county jail usage (and cost offsets) –Decreased shelter usage (and cost offsets) –Decreased use of other county funded systems, like emergency rooms, detox, hospitals –Increased quality of life –Leveraging state and federal funds to create a new pathway – housing – for needier users of county jail services

13. See it for yourself!

14. FUSE Blueprint: 3 Pillars, 9 Steps Data-Driven Problem- Solving Cross-system data match to identify frequent users Track implementation progress Measure outcomes/impact and cost-effectiveness 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 Policy and Systems Reform

15. FUSE is Always a Collaborative Effort Executive leadership (managers, commissioners) Corrections department Dept of social services/administrator of shelter services Housing authority County Partners Behavioral health agency Housing authority Homelessness leadership council State Partners Supportive housing providers Service providers CSH (where applicable) Foundation support Non-Profit Partners Executive leadership (Mayor, deputy mayor, commissioners) Police Housing authority City Partners (where applicable)

16. Assertive Recruitment Through Jail, Shelter, Hospital In-Reach 16 CourtsJail/PrisonStreetHospitalDetox Alcohol/Drug Treatment Shelter Psychiatric Hospital

17. Measure Outcomes and Cost-Effectiveness Measuring outcomes is critical to showing the effectiveness of the housing intervention! A 39% reduction in jail days in Hennepin Co. MN A 50% reduction in jail days in NYC Dramatic reductions in shelter use in both NYC and Hennepin Co. Lower rates of alcohol and drug use by tenants

18. Getting to Policy Adoption and Scale Bringing FUSE from pilot to full policy: –Early engagement of policymakers, budget officials around the FUSE “pilot” –Communication of outcomes and cost-offsets –Advance redirection of public spending from jails, shelters, etc. to supportive housing

19. Focus of Forum Demonstrate how FUSE can be adapted to your community Show by example how to overcome common obstacles (data privacy, limited housing resources, skeptical stakeholders) Create the beginnings of an action plan for your county to begin this work