The Chicago Housing for Health Partnership’s Approach to Housing and Health Care Integration
One of the challenges of serving individuals experiencing chronic homelessness is effectively integrating physical and behavioral health services with housing. The Chicago Housing for Health Partnership (CHHP), administered by the AIDS Foundation of Chicago, was created to address this problem head-on. Beginning as a demonstration project with 405 of the most severely ill, individuals experiencing chronic homelessness from 2003-2007, the project has continued on and is now a permanent citywide collaboration between three public hospitals, 10 supportive housing agencies with social services, and two programs providing respite care.
The CHHP program works within those three hospital social work departments to identify individuals experiencing chronic and non-chronic homelessness who are severely ill and connect them with respite care or supportive housing immediately upon their discharge from the medical facility. Individuals are also identified through outreach workers at supportive housing agencies. Individuals are then placed into housing using a Housing First and harm reduction model of housing placement.
A study of CHHP, published in the Journal of the American Medical Association, reported superior results. Participants provided with permanent housing and case management using the CHHP system used one-third less hospital inpatient days and one-quarter less emergency room visits than those who relied on the usual system of care. The cost savings for the subpopulation of those living with a chronic illness, including HIV/AIDS, is significant: “evidence suggests that for every 100 chronically homeless individual housed will save nearly $1 million in public funds per year, and for 100 short-term homeless living with a chronic illness housed, at least $660,000 in savings.”
For a fact sheet from the AIDS Foundation of Chicago on CHHP, click here.
USICH spoke with Arturo Bendixen, the Vice President for Housing Partnerships and the Director of CHHP, about what services are needed to best support individuals when they gain housing.
USICH: What have been some of the keys to success in the Chicago Housing for Health Partnership?
Bendixen:
- Agency-level leadership: The leadership of CHHP understood that without agency-level partnerships and coordination, integrated care wouldn’t happen. Case managers at each of these agencies do their best to create personal relationships with other agencies to coordinate an individual’s care, but their caseloads are often very large and they simply don’t have the resources to keep up. At both the case manager and client level, the work simply cannot be done effectively on an ad hoc basis. We brought together the executive directors of organizations that see these individuals most frequently in this agreement, and now they work together as closely as case managers coordinating their agency systems with one another. Instead of Agency 1 in partnership with Agency 2, they all are in agreement that they’re part of CHHP. The silos are broken.
- Coordinating entity: The AIDS Foundation of Chicago served as the coordinating entity and oversight manager of the project. AFC was granted funds directly through both HUD’s Supportive Housing Program and Housing Opportunities for Persons with AIDS (HOPWA). AFC then chose to subcontract with supportive housing providers with these funds. An agency with central control of funds for the project serves as the convener for the collaboration and ensures that all parties are indeed working together well. Coming from a grassroots service provider background, I understood that as a case manager or executive director of an agency you’re often so overwhelmed that the last thing you want to do is come to a meeting. But although CHHP network members are not part of a legal partnership but rather of a very strong collaboration, partnership agency staffs come to weekly or monthly meetings since it is part of their subcontract with AFC. Making collaboration an expectation with a central coordinating agency is key.
- Keep collaborations small: If we tried to do this partnership with 20 hospitals and 50 or more service providers it definitely would not have been successful. Over and above a contractual relationship, the small collaboration allowed executive directors to have more collegial relationships with their counterparts than they may have had with a larger network. At the end of the year, or at the end of a month, when we report our successes on the number of individuals we were able to house and the improvements in their overall health, all the agencies felt that success together. This close relationship also helps keep the collaboration strong after many years.
USICH: What needs to be in place for an integrated network like this to work for individuals experiencing chronic homelessness?
Bendixen: There are really four things that need to be in place for an integrated system like CHHP to be successful in providing services to the most hard to reach, long-term homeless: a well-trained outreach team, shared documentation and assessment, day-in and day-out collaboration, and a commitment to Housing First and Harm Reduction.
- Outreach: This is one of the front doors for individuals experiencing chronic homelessness into CHHP– the other is through their admittance into a hospital. A lot of highly vulnerable individuals who have been on the streets for a long time have engaged with many providers over the years and don’t particularly trust us. They’ve experienced our lack of resources and then having to go to so many different places for help, they just drop out of the system altogether. In order for supportive housing programs and health providers to engage this population effectively, they need to engage them where they’re at. One of the most important things outreach workers need to be trained on is working with people to get all their paperwork together to help them get approved in housing quickly– their prescriptions, identification, medical records (if they have any), social security. All these documents may be difficult to track down, but training outreach workers on what precisely individuals need to get into supportive housing helps to speed the process along.
- Shared documentation and assessment: In order for all agencies in the network to really understand what is going on with a particular individual and for an individual to stay engaged, it is important that each agency has access to all documentation and assessment on the individual. A lot of the reason why these individuals may not trust the system is because every time they go from one place to another (e.g. hospital to respite care to transitional housing) they get the same assessment and are asked the same questions. With the ability for all network members to see medical records, for example, service providers at every step know precisely what health care each individual needs and plan accordingly. The Affordable Care Act will be able to improve this with the shared electronic records mandate.
- Day-in and day-out collaboration: Social workers from each hospital and case managers from housing agencies get together every week to discuss the needs and status of individuals they’re working with, especially in the first six to 12 months that an individual is in CHHP. This in-person case review process helps to keep track of everyone each agency is working with and also continues to build the collaboration. Again, these folks saw themselves, not only as staff members of their own health or housing agency, but also CHHP case managers together with shared goals.
- Housing First and Harm Reduction: Success with this population of individuals who are severely ill and experience chronic homelessness doesn’t work without both a Housing First and Harm Reduction approach. Simply put, without this approach CHHP would not be successful and we wouldn’t be able to reach the people with the most need.
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