Frequent Users Systems Engagement (FUSE)
FUSE identifies and works to engage and stabilize people who are high users of both the shelter system and the criminal justice system, using a Housing First model of permanent supportive housing. The program model focuses on providing housing stability and reducing the involvement of participants in the criminal justice system and other emergency service systems.
Problem or Challenge:
In many communities a small number of people with complex, unmet needs who experience homelessness are frequently involved in the criminal justice system, and also frequently use shelters and emergency health care. They often have long histories of homelessness and untreated or poorly managed mental illnesses and addictions. Their frequent stays in county or city jails, shelters, hospitals, and sobering centers result in extraordinarily high costs in multiple public systems, but fail to improve the outcomes for the individuals or their communities.
The Corporation for Supportive Housing (CSH) has worked with local stakeholders in several communities to plan and implement Frequent Users Systems Engagement (FUSE) Initiatives. FUSE identifies and works to engage and stabilize people who are high users of both the shelter system and the criminal justice system, using a Housing First model of permanent supportive housing. The program model focuses on providing housing stability and reducing the involvement of participants in the criminal justice system and other emergency service systems.
Three essential pillars are at the core of the FUSE model:
Data-Driven Problem Solving: Data is used to identify a specific target population of high-cost, high-need individuals who are shared clients of multiple systems, including jails, homeless shelters, and crisis health services. Data analysis is used to identify those individuals who are caught in a “revolving door” with repeated contacts with several systems. Cross system data is also used to track implementation progress and measure outcomes.
Policy and Systems Reform: Policymakers and leaders from multiple systems are engaged in a collaborative effort to address the needs of shared clients and to shift resources away from costly crisis services toward more cost-effective and coordinated solutions. Multi-sector working groups include representatives from corrections, including the court system and probation/parole, homeless assistance system, public housing agencies, and health and behavioral health services.
Targeted Housing and Services: Permanent supportive housing with individualized supportive services is enhanced with targeted and assertive recruitment through in-reach into jails, shelters, hospitals, and other settings. Identified clients are engaged in services and connected to housing opportunities with the supports they need to achieve stability and avoid or reduce returns to crisis services and institutions. Permanent housing can be provided in site-based supportive housing, including new or “turnover” units set aside for FUSE participants in an apartment building, or using rent subsidies (such as housing vouchers) and housing location services to help participants rent apartments in scattered-site models of supportive housing.
Implementation and early evaluation results have highlighted some valuable lessons.
In-reach and immediate connections to housing are critically important. In-reach services are provided by staff members who work to establish a relationship with individuals who have been identified as eligible for program participation, while they are still in a jail, shelter, or hospital setting. Often the timing for a person’s release from jail is hard to predict, and this can create challenges when planning to make housing available immediately. Coordination and communication are critical as someone prepares to leave an institution. The first few days after release can be a critical time period for helping an individual avoid problems that could lead to a quick return to jail or the hospital. If permanent housing is not available immediately, it is important to have interim housing options available.
Flexible and robust services are critical. Services should be most intense at the beginning of the program to engage individuals, help with finding and moving into housing, and other challenges related to the transition to life in the community. The ratio of case managers or other service providers to program participants should be low (1:10 to 1:15) to allow case managers to provide the level of attention needed to advocate for clients and focus on reducing risky behaviors. Case managers should be knowledgeable about criminal justice systems and be able to advocate for individuals in courts or other justice settings. Team models and strategies such as motivational interviewing can be effective, particularly for participants who have not been successfully engaged in other models of treatment for mental health or substance use disorders.
Accurate and comprehensive assessments of clients’ service needs, including mental health and substance use conditions, and criminogenic risk factors are essential to match the right housing and services interventions to each individual.
Cultivating champions within the corrections system is critically important and can have a big impact. Thoughtful leaders in the corrections system often recognize that there are better solutions to the problems associated with homelessness and untreated mental illness or addiction, and they can be credible and powerful allies.
Collaborative problem-solving is needed to identify and work to remove systems barriers to effective housing placement and reduced recidivism. Systems need to be in place for housing and service providers, corrections staff, and shelters to communicate on an ongoing basis about individual cases while also working together to change policies and procedures that create barriers to housing for people who experienced homelessness prior to incarceration and are likely to return to homelessness when they return to the community. Negotiations with public housing authorities can result in changes to screening and eligibility criteria for housing subsidies.
Peer-to-peer visits can facilitate information exchange among leaders, policymakers, practitioners, and advocates, particularly when they have the opportunity to visit communities that have implemented promising programs.
Evaluations of FUSE projects are underway in several cities and states. Early results are promising and include:
39% reduction in the number of days in county jail and 83% reduction in the costs of jail, detox, shelter, and emergency rooms for participants in the Hennepin County, Minnesota FUSE program.
99% decrease in shelter days and 73% decrease in jail episodes for FUSE participants housed for 12 months or more in Connecticut.
50% reduction in the number of days in jail for participants in New York City FUSE program, compared to a comparison group, and a 92% decrease in shelter days.
The Corporation for Supportive Housing is working with local and national partners to plan, implement, and evaluate the FUSE model in several cities and states. More information is available on the CSH website at http://www.csh.org/csh-solutions/community-work/systems-change/fuse
A report summarizing the findings from several evaluations, including outcomes and lessons learned, is posted at http://www.csh.org/resources/returning-home-emerging-evidence-and-lessons-learned
A more in depth description of systems change accomplishments and lessons learned through implementation of FUSE and other reentry supportive housing initiatives is contained in a report by the Urban Institute http://www.urban.org/UploadedPDF/412157-returning-home-initiative.pdf
Evidence-Based Practice: Housing First
Evidence-Based Practice: Permanent Supportive Housing
Evidence-Based Practice: Motivational Interviewing
Promising Practice: Frequent Users of Health Services