Written by Kendra Kramer, Intern for FUSE - Housing First
Master of Public Health Candidate | Class of 2016
University of Iowa College of Public Health | Community & Behavioral Health
Approximately three years ago, the idea of implementing a FUSE – Housing First program in Iowa City was simply a strategic goal for the Johnson County Local Homeless Coordinating Board (LHCB).
Fast forward to today, and an in-depth case-study has been completed, collaboration across multiple agencies and departments has been facilitated, relationships with social services in the Iowa City area have been built, and progression from the assessment to planning phase has been accomplished.
This concept of “Housing First” is a relatively new strategy to ending homelessness. It works just like it sounds: the first and ultimate goal is putting individuals into housing; no conditions exist. Participants aren’t required to take sobriety tests, drug tests, participate in any sort of case-management, or meet any other requirements in order to be able to participate. However, these services are available and easily accessible if desired.
This unconditional aspect of the Housing First model is essential. When stipulations are required and individuals fail to meet them, their only option is to resort back into homelessness. The Housing First model works to break this cycle of system entry and exit by focusing first on housing, then providing services to those interested.
This idea of Housing First has caught fire, and not just in Iowa City.
At completion of the pilot, emergency room visits were down by 77%, arrests were down 69%, jail days were down 43%, in-patient medical stays were down 73%, and the per person average decreased from $317,904 in 2010 to $97,437 in 2011. (See Figure 1 for more details).
Based off of successes such as Project 25, the Hennepin County FUSE Program in Minnesota, Portland’s Frequent User Permanent Supported Housing Program and many others, the LHCB decided to complete a case study within Iowa City.
This case study consisted of four individuals that were determined to be among the most chronically homeless individuals in Iowa City and frequent users of medical services, police departments, homeless shelters, and other various social services. Among these four individuals, the results were eye-opening.
This isn’t surprising when considering that for this population, managing chronic conditions or seeking primary care services falls significantly behind finding a place to sleep at night and protecting their belongings. Most are unwilling to engage with services on a regular basis, due to complex behavioral and social issues, as well as severe mental illness and substance addiction, and only seek help when in crisis.
In addition, many of these individuals live outdoors in extreme weather and potentially dangerous environments. (See photos below). When these individuals are in need of medical services, they often seek it through emergency departments; an expensive endeavor.
A vital part of this Housing First initiative that is imperative for program success is accurately identifying those who are the most chronically homeless frequent users. When looking at the entire homeless population, frequent users only make up between four and five percent of that population.
Traditional approaches to care just don’t work for them. However, letting them continue to cycle through high-cost crisis services both doesn’t improve their standard of living and costs the community hundreds of thousands of dollars each year.
The Housing First approach to these high-needs, highly-vulnerable, chronically homeless individuals has proven to be effective. FUSE – Housing First does not place conditions of housing on the behavior of participants, effectively ending the ongoing cycle of entering and exiting high cost services. Supportive services are available, and intended to prevent returns to homelessness and provide healthcare care on an ongoing and regular basis—catching problems early before they become a crisis.
When these individuals don’t have to worry about where they are going to sleep at night and are provided essential services, their well-being improves and they aren’t using high cost services (i.e. jails, emergency departments, homeless shelters, etc.) as frequently.
This FUSE –Housing First model is a 3-pronged approach using permanent supportive housing, data driven problem solving, and cross-system collaboration to help bring an end to chronic homelessness. At this point, the LHCB is in the planning phase on the path to implementing this program. Currently, funding sources are being researched, potential housing opportunities are being explored, and other details continue to be discussed. The case study has demonstrated the pressing need to care for this population, and the consequences to our community of letting things continue as they are.
We believe that our FUSE – Housing First program can be a solution and hope that you continue to follow our progress!