How state policy and local context is shaping implemention of an innovatiave program for homeless individuals

Many public health and homeless service providers believe that the costs incurred by high-risk, medically needy homeless individuals could be reduced through the use of housing programs that integrate medical care management models and social service case management models. We report here on several broad, policy-relevant challenges of just such an effort: a demonstration project operated by the Corporation for Supportive Housing and supported by The Center for National and Community Service’ Social Innovation Fund, which attempts to integrate supportive housing with managed medical care for homeless high-utilizers in four program sites: Los Angeles County, San Francisco, Washtenaw County, MI, and several cities in Connecticut. Although all sites sought to implement the same model, the adaptation of the program model to state policies and local conditions has produced four distinct programs that vary substantially in the publicly funded services that are provided and the number and type of clients reached.  This paper explores the ways in which differences in state and local realities have constrained and reshaped an innovative model intended to provide integrated housing, health, and social services to homeless individuals with high medical costs.

Using data collected for the program’s evaluation, this presentation provides numerous examples of variation in local policies, populations, and service resources that have produced substantial differences in service mix, staffing, and client enrollment across the program sites. These include:

• The challenges of implementing multiple data-driven approaches used to identify and engage individuals who could benefit from such a program.

• Variations across sites in the availability of housing and housing vouchers, which have had dramatic implications for enrollment.

• Differing strategies in developing collaborative relationships between key social and health service providers, which have taken several forms and have not always been easy to formalize and maintain.