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

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

3. 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.

4. 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)

6. 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

7. 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.

8. 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%

9. 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%

10. 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

11. 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.

12. Center for Healthcare Research &Transformation
Carrie Rheingans, MPH, MSW
2929 Plymouth Road Suite 245
Ann Arbor, MI 48105
(734)
Website: