Ending the Cycle of
Homelessness and Incarceration
Through Supportive Housing
June 7, 2012
Andy McMahon, CSH
Corporation for Supportive Housing
CSH helps
communities create
permanent housing
with services to
prevent and end
Goal of CSH and NACo
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
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
The Intersection of Systems and Issues
County Jail
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
A Small Number of
Very High Risk
Homeless Persons
At risk for extensive need of health
and justice system services
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
Sheriff mental health
Sheriff medical jail
Sheriff general jail
LAHSA homeless
GR Housing
General Relief
•The most expensive 10% of
homeless persons have
average monthly costs
$6,529, regardless of whether
they are homeless or housed
Food Stamps
Public Health
Mental Health
Private hospitals-ER
Health Srv - ER
Highest Decile
Ninth Decile
Eighth Decile
Seventh Decile
Sixth Decile
Fifth Decile
Fourth Decile
Third Decile
Second Decile
Source: Economic Roundtable, 2011
Lowest Decile
The greatest cost savings can be achieved by prioritizing high-risk individuals
Health Srv
outpatient clinic
Private hospitalsinpatient
Health Srv hospitalinpatient
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.
What is Supportive
Supportive housing is a costeffective combination of
permanent, affordable housing with
services that help people live more
stable, productive lives.
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
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
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
See it for yourself!
FUSE Blueprint:
3 Pillars, 9 Steps
Data-Driven ProblemSolving
Policy and Systems
Targeted Housing and
Cross-system data match
to identify frequent users
Convene interagency and
multi-sector working
Create supportive housing
and develop assertive
recruitment process
Track implementation
Troubleshoot barriers to
housing placement and
Recruit and place clients
into housing, and stabilize
with services
Measure outcomes/impact
and cost-effectiveness
Enlist policymakers to
bring FUSE to scale
Expand model and house
additional clients
FUSE is Always a
Collaborative Effort
County Partners
State Partners
City Partners
(where applicable)
• Executive leadership (managers, commissioners)
• Corrections department
• Dept of social services/administrator of shelter services
• Housing authority
• Behavioral health agency
• Housing authority
• Homelessness leadership council
• Supportive housing providers
• Service providers
• CSH (where applicable)
• Foundation support
• Executive leadership (Mayor, deputy mayor,
• Police
• Housing authority
Assertive Recruitment Through
Jail, Shelter, Hospital In-Reach
Measure Outcomes
and Cost-Effectiveness
• Measuring
outcomes is critical
to showing the
effectiveness of the
• A 39% reduction in jail
days in Hennepin Co.
• 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
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
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
• Create the beginnings of an action plan
for your county to begin this work