Homelessness is not an isolated issue, and those experiencing chronic and long term homelessness all too often cycle between different institutions without solving the underlying issues keeping them stuck there. The FUSE model pioneered in New York by CSH and subsequently adapted across the US seeks to break the cycle of incarceration and homelessness. It recognised that the unresolved needs of a section of “super utilizers” leading chaotic lives cycling between shelters, jail and hospitals, was generating significant public cost; nationally CSH estimated about 5% of people were consuming 50% of the public resources.
Central to the FUSE model is the Housing First approach, which recognises that the biggest barrier for chronically homeless clients is lack of a stable place to recover. In New York, targeting this population with Permanent Supportive Housing (PSH) resulted in 40% reduction in days spent in jail, and 38% reduction in jail admissions over 2 years. 90% reduction in shelter admissions and days in a shelter, and 55% reduction in days spent in a psychiatric hospital over 2 years.
The MeckFUSE partnership of agencies in Charlotte, North Carolina is one of the most successful adaptations of the model nationally, and includes homelessness agencies, jails, and healthcare providers. I spent some time with the MeckFUSE team to learn about how data is used to drive decision making. Individuals offered housing through MeckFUSE were identified who had at least 4 jail and 4 shelter admissions in a 5 year period and the data was cross matched with behavioural heath systems and homelessess.
Several elements of the model work particularly well here, including the strong partnership of agencies committed to the Housing First approach, intelligent use of local data, aided by a strong input from Charlotte university, and a proactive staff team who are responsive to their clients. Engagement begins in the jails, who are key stakeholders and allow in reach from the case managers who start to build relationships with those clients identified as eligible for the programme.
Teresa was one of the first MeckFUSE clients housed in PSH in Charlotte, having spent 20 years cycling in and out of shelters and jails, on drug related charges and sporadic prostitution. Like many chronically homeless individuals who end up committing petty crimes to get by, jail had become a part of her life, and incarceration was no deterrent to offending. As an alternative to the harsh life she was living on the streets she viewed jail place of safety, where she could get a roof over her head and a meal. When she was offered a home via MeckFUSE it came with virtually no conditions attached which took some time for her to get used to: “I couldn’t believe it, why would this be handed to me”. Remembering her first day in her new home, she said simply: “it was empty, like me”.
Crucially for her success in staying with the program, in accordance with Housing First principles getting off drugs was not a requirement of housing. Teresa admits that she continued to use for a while after becoming permanently housed, but she got a lucky break when, up on another charge she was sent to a residential rehab instead of jail. She got clean and significantly she addressed deeply rooted trauma issues from her past. From that moment on she says she felt like “a new woman, a different person”. She broke free of her previous associates, and when they turned up at her house with “rocks in their pocket” they were sent on their way with a promise to call the police if they returned.
I visited Teresa at her home, which is comfortable and well cared for. It wasn’t easy for her to kick her drug dependency but she has been clean for many months now. She no longer needs to attend the meetings she used to attend up to 3 or 4 times a day in the early days, and is studying for her high school diploma with the aim of becoming a pastor. She hopes to use her experiences to set up a shelter for women on the street.
I have seen first hand here that solving homelessness requires acknowledgement of the complexity of the issues at hand; there is no easy answer. Use of data and value driven partnershop working can be used to identify those individuals who can most benefit from limited resources but people have complex lives and the focus of solutions and resources must similarly be multi-layered.
Coming home: ending cycles of homelessness after leaving prison 