Frequent Users Systems Engagement (FUSE)€¦ · By providing housing navigation, intensive case...
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1 ✦ Cross-sector Partnership: The community brought together a diverse collaborative of hospitals, housing agencies, health centers, behavioral health providers, social service organizations and government agencies. ✦ Data-Driven Strategy: Data matching across multiple systems was used to identify high utilizers during the early part of the study. The project moved to referrals based on a utilization threshold. ✦ Outreach, Engagement, and Recruitment: An Outreach Coordinator provides assertive outreach into hospitals, jails, institutional and other homeless service settings. ✦ Housing: Multiple partners came together to increase access to housing. PSH units, owned, and operated by Avalon Housing, are prioritized for project participants. The local public housing authority (PHA) provides public housing units and Housing Choice Vouchers.Two local housing providers provide Shelter Plus Care subsidies. ✦ Integrated Health and Housing Services: A strong partnership between Avalon Housing, hospital systems, and the local health center elevates inpatient care coordination and access to primary care. ✦ Rigorous 3rd Party Evaluation: This project is being independently evaluated by NYU using a control and intervention group, a process evaluation with annual site visits and key partner interviews. ✦ Building Community: Community building is an integral aspect of the services model with an average of 75 community events each month. ✦ Bring together community partners from a variety of sectors to connect frequent users to housing, healthcare, and care coordination is both the goal and lasting outcome of the Frequent Users Systems Engagement (FUSE) initiative in Washtenaw County, Michigan – a subgrantee of the CSH’s Social Innovation. Other health centers, housing and service providers can learn and replicate these coordination efforts. Avalon Housing, a permanent supportive Housing First provider, is the lead agency for this initiative. They work closely with the University of Michigan Health System, St. Joseph Mercy Health System, Packard Health (the local Health Center Program grantee), Community Mental Health, the Shelter Association, the Ann Arbor Housing Commission, and other service providers. ✦ The FUSE project targets individuals who meet threshold criteria for frequent utilization of crisis systems, including homelessness or housing instability, low income, behavioral health conditions, chronic physical health conditions, and frequent emergency room utilization and/or hospitalizations. ✦ By providing housing navigation, intensive case management, and care coordination for primary and behavioral health services, the FUSE project intends to demonstrate a reduction in use of emergency systems, improved health outcomes for fragile individuals, and cost savings across multiple systems. ✦ Challenges: Affordable housing resources are limited in Washtenaw County’s high rental market, and state budget cuts have resulted in a reduction of available vouchers. The research study was delayed by unanticipated work needed to meet Institutional Review Board (IRB) requirements, which in turn delayed the start of the program. Sustainable funding also remains a challenge. ✦ Opportunities: Avalon’s 20 years of PSH experience, and Washtenaw’s existing provider relationships through the Continuum of Care and other local coordinating bodies provided a solid foundation to build on. Effective community prioritization through a central access point made for clear and effective targeting. INITIATIVE OVERVIEW Frequent Users Systems Engagement (FUSE) Washtenaw County, MI | April 2016 KEY FEATURES & INNOVATIONS
Transcript of Frequent Users Systems Engagement (FUSE)€¦ · By providing housing navigation, intensive case...
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✦Cross-sectorPartnership:Thecommunitybroughttogetheradiversecollaborativeofhospitals,housingagencies,healthcenters,behavioralhealthproviders,socialserviceorganizationsandgovernmentagencies.
✦Data-DrivenStrategy:Datamatchingacrossmultiplesystemswasusedtoidentifyhighutilizersduringtheearlypartofthestudy.Theprojectmovedtoreferralsbasedonautilizationthreshold.
✦Outreach,Engagement,andRecruitment:AnOutreachCoordinatorprovidesassertiveoutreachintohospitals,jails,institutionalandotherhomelessservicesettings.
✦Housing:Multiplepartnerscametogethertoincreaseaccesstohousing.PSHunits,owned,andoperatedbyAvalonHousing,areprioritizedforprojectparticipants.Thelocalpublichousingauthority(PHA)providespublichousingunitsandHousingChoiceVouchers.TwolocalhousingprovidersprovideShelterPlusCaresubsidies.
✦IntegratedHealthandHousingServices:AstrongpartnershipbetweenAvalonHousing,hospitalsystems,andthelocalhealthcenterelevatesinpatientcarecoordinationandaccesstoprimarycare.
✦Rigorous3rdPartyEvaluation:ThisprojectisbeingindependentlyevaluatedbyNYUusingacontrolandinterventiongroup,aprocessevaluationwithannualsitevisitsandkeypartnerinterviews.
✦BuildingCommunity:Communitybuildingisanintegralaspectoftheservicesmodelwithanaverageof75communityeventseachmonth.
✦ Bringtogethercommunitypartnersfromavarietyofsectorstoconnectfrequentuserstohousing,healthcare,andcarecoordinationisboththegoalandlastingoutcomeoftheFrequentUsersSystemsEngagement(FUSE)initiativeinWashtenawCounty,Michigan–asubgranteeoftheCSH’sSocialInnovation.Otherhealthcenters,housingandserviceproviderscanlearnandreplicatethesecoordinationefforts.AvalonHousing,apermanentsupportiveHousingFirstprovider,istheleadagencyforthisinitiative.TheyworkcloselywiththeUniversityofMichiganHealthSystem,St.JosephMercyHealthSystem,PackardHealth(thelocalHealthCenterProgramgrantee),CommunityMentalHealth,theShelterAssociation,theAnnArborHousingCommission,andotherserviceproviders.
✦ TheFUSEprojecttargetsindividualswhomeetthresholdcriteriaforfrequentutilizationofcrisissystems,includinghomelessnessorhousinginstability,lowincome,behavioralhealthconditions,chronicphysicalhealthconditions,andfrequentemergencyroomutilizationand/orhospitalizations.
✦ Byprovidinghousingnavigation,intensivecasemanagement,andcarecoordinationforprimaryandbehavioralhealthservices,theFUSEprojectintendstodemonstrateareductioninuseofemergencysystems,improvedhealthoutcomesforfragileindividuals,andcostsavingsacrossmultiplesystems.
✦ Challenges:AffordablehousingresourcesarelimitedinWashtenawCounty’shighrentalmarket,andstatebudgetcutshaveresultedinareductionofavailablevouchers.TheresearchstudywasdelayedbyunanticipatedworkneededtomeetInstitutionalReviewBoard(IRB)requirements,whichinturndelayedthestartoftheprogram.Sustainablefundingalsoremainsachallenge.
✦ Opportunities:Avalon’s20yearsofPSHexperience,andWashtenaw’sexistingproviderrelationshipsthroughtheContinuumofCareandotherlocalcoordinatingbodiesprovidedasolidfoundationtobuildon.Effectivecommunityprioritizationthroughacentralaccesspointmadeforclearandeffectivetargeting.
INITIATIVEOVERVIEW
Frequent Users Systems Engagement (FUSE)
Washtenaw County, MI | April 2016
KEYFEATURES&INNOVATIONS
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History ✦ AvalonHousinghasbeenprovidingpermanentsupportivehousingforovertwentyyearsandhasastronghistoryof
activismandadvocacyinthecommunity.✦ SystemslevelcollaborationwiththeWashtenawHousingAllianceandstrongmentalhealthadvocacyfromCommunity
MentalHealth'sstreetoutreachteamhelpedlaythegroundworkforthisinitiativetosucceed.✦ AtthestartoftheFUSEproject,thepreviousleadagencyhadaprograminplacewiththelocalambulanceserviceto
providecasemanagementtofrequentutilizers.✦ Existingsupportivehousingteamshadbroughttolighttheentanglementofthehealthcareandhomelessservicesystems,
andthelackofcommunicationandcoordinationacrosssystems.WashtenawCountywaswellpositionedtoparticipateintheSocialInnovationFundopportunityandshareexperiencewiththeotherthreeresearchsites.
✦ TherelationshipwiththeUniversityofMichiganComplexCareManagementProgramhelpedjump-starttheformalcollaborationandthedata-driventargetingprocesswithU-Mandotherpartners.
Target Population
Approach TheWashtenawCountyFUSEinitiativeadoptedateam-basedapproachtocarewithintensivecasemanagementservingasanintegralcomponent.Theteammeetsweeklytodiscussincomingreferrals,careplansforcurrentclients,andcomplexcases.FUSEclientswereinitiallyidentifiedthroughadatamatchprocesswiththetwohospitalsystems,homelessshelterproviders,andbehavioralhealthproviderstocreatearecruitmentlist.Nowinitsfourthyear,theprojecthasmovedtoadirectreferralsystemusingtheutilizationthresholdlistedabove.
Onceidentified,theoutreachcoordinatorworkstoengagetheindividual,locatehousing,andassiststheparticipantthroughmove-in,wheretheyareassignedacasemanager.CaseManagersmaintainlowcaseloads,withanaverageof1:20,balancedbytheacuityofclientneed.Theycompleteacomprehensiveassessment,andlinkthemtoneededsupportssuchasmedicationmanagement,legaladvocacy,employmentandeducation.CaseManagerscoordinatecaretoaddressphysicalandbehavioralhealthneeds,linkingclientstoaprimarycareproviderandassistingwithnavigationofmentalhealthandsubstanceabusetreatmentsystems.Theteamistrainedonevidence-basedpracticessuchasmotivationalinterviewing,assertiveoutreach,traumainformedcare,housing-firstandharmreductionapproaches.
PackardHealth,theHealthCenterpartner,providescomprehensiveprimarycareandintegratedservicesthroughtheirPatientCenteredMedicalHomemodelandisworkingtoprovideonsiteservicestoFUSEparticipants.PackardalsodesignatedanursepractitionertoparticipateontheFUSEcareteam,whichhelpstocreateawarmhand-offintoprimarycarefromhospitalandhousingpartners.TheirparticipationisinrecognitionofthevalueofstabilizinghealthandprovidingpreventativecareinadditiontostablehousingtopreventfutureERvisitsandhospitalizations.
Frequent Users Systems Engagement: Washtenaw County, MI
INITIATIVEDETAILS
✦ Verylowincome
✦ Haveadiagnosedmentalhealthconditionorsubstanceusedisorder
✦ Oneormorechronicphysicalhealthcondition
✦ Homelessorinpersistenthousingcrisis
✦ Highutilizersofcrisishealthservices-definedas(1)8ormoreERvisitsor(2)1ormorehospitalizations&3ERvisitsinlastyear
Housing
IntensiveCaseManagement
Identify&LocateParticipant
HousingNavigation
OutreachCoordinator
HealthSystemCoordination-PCP,HospitalBehavioralHealthPartnerships
Employment&EducationSupport24/7CrisisIntervention
Landlord/TenantMediation
Referrals
CoordinatedAccess
Hospitals
DataMatch010101010101010101010101010101010101010101010
101010101010101010101010101010101010101010101
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Goals
Outcomes
OUTCOMES
Frequent Users Systems Engagement: Washtenaw County, MI
“PriortoFUSEIselfmedicated.Iwasgettingkickedoutofeverywhere.ItriedtotakemyselfoutacoupleoftimesandthenImetmyFUSE
worker.Shehashelpedmesomuch.I’vebeenhousedforalmostthreeyearsnow.IthinktheFUSEprogramissoawesome.Iwouldn’tchange
anything.EventhoughbadstuffhashappenedI’mnotahotmessanymore.Idon’tdrinklikeIusedto.Idon’thavetogototheemergencyroomalotanymore.IfIdon’tanswermydoorIget15milliontextsfrom
myworker.I’minamuchbetterplace.FUSE,theyrock,theydo.
BeingwithFUSEIdon’tgotothehospitalanymore.IhavearegulardoctorIgoandsee.I’vegainedweightsoI’malittlehealthier.Ilikethefactthattheycareabouthealthinessandaboutwhatwethink.Theone
ononefacetofacewithusmakesadifference.”
-Lamethia,FUSEParticipant
SystemLevel:
ReducePublic&PrivateHealthCareCosts
BreakDownSystemicBarrierstoCoordinatingCare
IncreaseVisibility,Awareness,&Understanding
BuildaSolidBasetoEngageLocalandStateLevel
PolicymakerstoStimulateSystemChangesthatWork
TowardSustaining&DisseminatingtheModelofCare
BreakDownBarrierstoRapidAccesstoHousing
IntegrateAffordableHousingResourceswithHealthCare
SystemDecreaseMortalityRates
ProgramLevel:
ReduceUtilizationofDetoxFacilities,Shelters,Jails,etc.
ReduceEmergencyRoomUtilization
ReduceMedicalandPsychiatricInpatient
AdmissionsandHospitalDays
ParticipantLevel:
ReduceSubstanceUse
ImprovePhysicalHealthbyIncreasedPrimaryCareUtilization
ExitHomelessness&IncreaseHousingStability
ImproveMentalHealthbyIncreasedServiceEngagement
Quantitative:
87%EnrolledinPrimaryCare
ReductioninInappropriateERandHospitalUsage(In20154thQuarter:46%participantshadnoER
utilization,56%participantshadnoinpatientstays)
HighHousingRetentionRate:81%IncludingNegativeExits(Hospitalization,Incarceration,Evictions,Deceased)101Housed,4Evictions
Qualitative:
ImprovedQualityof
Life
IncreasedBodyofEvidence,Awareness,andRecognitionLocallyandattheStateLevelRegardingPSHModelandits
Impact
ImprovedSystemsLevel
CareCoordination
BridgedGapsinPreviously
FragmentedServiceSystems
WiderAcceptanceofHarmReductionOrientedCareattheCommunity
Level
Multidisciplinary,Cross-systemCareTeamEstablished
Challenges ✦ Sequestration:Thenationalbudgetsequestrationin2013impactedtheabilityofthesitetoaccessHousingChoiceVouchersfrom
thelocalPHAwhenthatresourcedecreased.Thismeantvoucherswerenotavailableforaperiodoftimeintheearlystartupphaseoftheproject.However,theyovercamethischallengebyleveragingotherstateandlocalhousingresources.
✦ HousingMarket:WashtenawCountyhasahighrentmarket.Thefairmarketrentlocallyissometimeshigherthanthevoucherlimit.Thereisalowvacancyrateinthemarket,makinglandlordrecruitmentachallenge.
✦ HarmReduction:Ashiftinthepredominantphilosophyofcarewasneededinordertoimplementharmreductionorientedcareatthecommunitylevel.WashtenawCountyhaslimitedaccesstosubstanceuseservicesforindividualswithsubstanceusedisorderswhoareinapre-contemplativestageofchange.
✦ IRBProcess:ThelocalhealthsystemsrequiredIRBapprovalforboththeevaluationanddatamatch.IRBapprovalandsubsequentamendmentscreatedprogrammaticdelaysandunplannedadministrativeburden.
✦ Medicaid:LimitedMedicaidbillingoptionscreatecomplexities.AvalonHousingisacontracted“CommunityLivingSupports”providerwithCommunityMentalHealth(CMH),Washtenaw.UnderthisarrangementthereisonlyoneMedicaidcodethatAvaloncanbillunder.TobillunderthiscodeindividualshavetobeopentoCommunityMentalHealthandmeetmedicalnecessityforthisservice.Whileitishelpfultohavethisstablefundingstreamtosupportsomeoftheirclients,billableservicescoveredunderthecodedoesnotadequatelycapturethescopeofwork.
✦ HUDFunding:HUDfundingprioritizeschronicallyhomelesspopulation.ThetargetpopulationwasbroaderandcreatedlimitationsontheWashtenawCounty’shousingoptionsforthosewhodonotmeetthesecriteria.
✦ ComplexNeeds:Thetargetpopulationexperiencescomplexmedicalandbehavioralhealthneedsthatsomestaffwerenotequippedtohandle.Thecommunityisworkingonexpandingtheskillsetofstafftomeetcomplexneedspopulation.
Opportunities ✦ Zero:2016:BeingaZero:2016 communityhelpedtoimproveWashtenawCounty’scoordinatedassessmentprocess.1
✦ EstablishedPSHProgram:AvalonHousing’s20yearhistoryofprovidingPSHenabledtheFUSEinitiativetobuildonawellestablished,successfulprogrammodelandinfrastructure.
✦ Collaboration:Dedicatedcommitmentsfrompartneragencieshelpedtocreateatruecrosssystemscollaborativeapproach.
✦ CareModel:Eachhealthsystemhadanestablishedcaremodel,whichallowedfornaturalpartnershipstodevelop.Forexample,theUniversityofMichiganHealthSystemcreatedaComplexCareManagementProgram,whichcoordinateswithprimarycare,communityproviders,andsupportagenciestoservepatientswithahighlevelofneed.
✦ PHAPartner:AvalonHousinghasastrongpartnershipwithlocalPublicHousingAuthority.ThePHAhascreatedapreferenceforpeopleexperiencinghomelessnessforpermanenthousingandrenovatedanexistingsinglesitehousingcomplex.
✦ LeveragingResources:TheFUSEinitiativehasallowedthecommunitytoleveragenewfundingsourcesandhousingresources,includingdirectfinancialassistancefromoneofthehealthsystems,whichwillserveasanopportunitymovingforward.
Zero:2016 is a Community Solutions Initiative involving communities around the country working to end veteran and chronic homelessness. 1
https://cmtysolutions.org/what-we-do/zero-2016 �4
Frequent Users Systems Engagement: Washtenaw County, MI
CHALLENGESANDOPPORTUNITIES
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Avalon Housing KeyRole:AvalonHousingistheleadagencyforthisproject.TheyareasupportivehousingandserviceproviderandprovidecasemanagementtoFUSEparticipants. Hospital Partners: University of Michigan Health System - Complex Care Management Program & St. Joseph Mercy Health System Program for the Uninsured KeyRole:TwolocalhospitalsystemsworkwithcasemanagerstocoordinatecareandhealthsystemlinkagesfortheFUSEpopulation. Washtenaw County Community Mental Health KeyRole:WCCMHisthementalhealthservicesprovidertotheFUSEpopulation.Theyprovidementalhealthservicestoadultswithasevereandpersistentmentalillness,childrenwithasevereemotionaldisturbance,andindividualswithadevelopmentaldisability.
Washtenaw Health Initiative KeyRole:FUSEisanadoptedprogramoftheWashtenawHealthInitiative,thatprovidescountywidecollaborationfocusedonimprovedaccesstocareandfundraisesfortheFUSEinitiative. Packard Health KeyRole:FUSEprogramparticipantsarelinkedtoprovidersatPackardHealth,thelocalhealthcenterprogramgrantee,whichprovidesprimarycaretothemajorityofparticipantsandwilldesignateanursepractitionertobepartofthecareteam. Washtenaw Public Health and Washtenaw Housing Alliance KeyRole:BoththeWashtenawPublicHealthandWashtenawHousingAllianceassistedwithadvocacyandcommunityresourceprioritizationfortheFUSEinitiative. Ann Arbor Housing Commission KeyRole:AnnArborHousingCommissionprovidesHousingChoiceVouchersandpublichousingunitstotheFUSEprogram. Michigan Ability Partners and Shelter Association of Washtenaw County KeyRole:MichiganAbilityPartnersandtheshelterassociationprovideShelterPlusCarerentalsubsidiestotheFUSEprogram.
Frequent Users Systems Engagement: Washtenaw County, MI
INITIATIVEPARTNERS
BeforeAvalon,lifewashard,neverknowingwhereyouwillstayorwhatyouwilleat.Thinking,whereIcangotomeetmykids,howcanIstaysafe?In2011,afterlosingmyjobasanLPN,Ibecamehomeless.IhadstarteddrinkingheavilyandmyhusbandandIstruggledtofindplacestostay.Wewouldbouncefromfamilymembertofamilymember.Thenmyhusbandcommittedsuicide;thatwasayearago.AfterthatIlivedintents,theshelter,prettymuchanywhereIcouldstay.Tobehomeless,feelscrappy-
Thenyougetusedtoit.Itconsumesyourentireday.Ittakeshoursandhoursthinkingaboutwhereyouaregoingtolive,whereyouaregoingtostaysafe,whereyouaregoingtoeat.You’llthink—“HowdoImakethingsbetter”—butyouliveinthemoment.Somuchso,thereisnoplanningahead.Youdon’tknowwhatyouaregoingtowear,whereyouwillwashyourclothes,howyouaregoingtoseeyourkids.Thesethoughtsconsumeyou.Ihavethreechildren,onediedofSIDS,itwasverytraumatizing.TheUniversityofMichiganhospitalwastryingtohelpmestaysoberbecauseIwasspendingtime,alotoftime,intheEmergencyRoom.Butbeinghomelessishardbecauseyouwanttonumbupandnotfeeleverythingyoudofeel.Imeanwhowouldn’twanttofallasleepinsteadofyourmindracingallnightthinking.…”WhatamIgoingtodotomorrow?”
ThatiswhenIgotthecalltocometoAvalon.Theyareworkingwiththehospitals,PORT,andCSStohelp100peoplegetcounselingandgetoffthestreets.ItiscalledtheFUSEProgramandtheygiveyouhelpwithyourmedicalneeds,support,andhousing.
SinceIhavebeenhereatAvalon,Igettoseemykidsregularly.Igettoseemydoctorregularly,IcaneatwhenIwantandalltheresourcesIneedarehere.Mycaseworkerhashelpedmewithsomuch,morethanshewouldeveracknowledge.Shehelpedmeclearupoldwarrantsfromnotbeingabletopaytickets.Thosearethetypesofissuesthatkeeppeoplehomeless.
ThingshavegottenbetterandIhaveasecondjobnow.Littlebylittle,Igetbetter.ForalongtimeIfeltlikemylifewasnothingbutturmoilandIwasonaroadtoself-destructionandprobablydeath.Now,it’slikeIhaveashot,IgettomakeachoiceintheroadandIchooseAvalon—it’slikemybigsteppingstone.It’sgivenmetheopportunitytocomeupinlifeandnotdown.TheygivemetheresourcesthatIneed.Mylifeisnowprettygood.
KRISTIN’SSTORY
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Funding Sources Fundingfromthesesourcesisusedtocovercasemanagementanddata&oversight.
*SIFfundingmustbematchedbythecommunity.
Costs Savings Resultspending.
Program Costs
TotalAnnualCostwithRentalAssistance:$11,394
FUSE
St.JosephMercyHealthSystem$84,500
CommunityMentalHealth,WashtenawCounty
$102,000
SocialInnovationFund$200,000
WashtenawCountyCoordinatedFunders
$53,438
FINANCES
Frequent Users Systems Engagement: Washtenaw County, MI
0
3000
6000
9000
12000$250
$1,105
$3,809
$6,230RentalSubsidiesCaseManagementandHousingNavigationDataandOversightTransportation
ProgramCosts(PerClient)
HousingResources:✦ AvalonHousing:
• PSHUnits
✦ AnnArborHousingCommission(PHA):• PublicHousingUnits• HousingChoiceVouchers
✦ TwoLocalHousingProviders:• ShelterPlusCareSubsidies
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Frequent Users Systems Engagement: Washtenaw County, MI
CSHtransformshowcommunitiesusehousingsolutionstoimprovethelivesofthemostvulnerablepeople.Weoffercapital,expertise,informationandinnovationthatallowourpartnerstousesupportivehousingtoachievestability,strengthandsuccessforthepeopleinmostneed.CSHblendsover20yearsofexperienceanddedicationwithapracticalandentrepreneurialspirit,makingusthesourceforhousingsolutions.CSHisanindustryleaderwithnationalinfluenceanddeepconnectionsinagrowingnumberoflocal
communities.WeareheadquarteredinNewYorkCitywithstaffstationedinmorethan20locationsaroundthecountry.Visitcsh.orgtolearnhowCSHhasandcanmakeadifferencewhereyoulive.
ABOUTCSH
TheNationalHealthCarefortheHomelessCouncilisanetworkofdoctors,nurses,socialworkers,patients,andadvocateswhosharethemissiontoeliminatehomelessness.Since1986wehavebeentheleadingorganizationtocallforcomprehensivehealthcareandsecurehousingforall.Weproduceleadingresearchinthefieldandprovidethehighestleveloftrainingandresourcesrelatedtocare
forpersonsexperiencinghomelessness.Wecollaboratewithgovernmentagenciesandprivateinstitutionsinordertosolvecomplexproblemsassociatedwithhomelessness.Additionally,weprovidesupporttopubliclyfundedhealthcentersandHealthCarefortheHomelessprogramsinall50states.Visitnhchc.orgtolearnmore.
ABOUTNHCHC
AllphotosdepictstafforconsumersreceivingservicesfromtheWashtenawCountyFUSEprogram.
“TheFUSEprogramtakesmetoallmydoctors,checksinonme3-5timesaweek.NomatterhowmuchhelpIneededtheyalwayshelpedme.I’ve
beenhousedforalittleoverayearnowandI’mveryhappytobeonmyown.Idon’tknowwhatI’ddowithoutmy
FUSEworker.Shetriestomakeherselfavailableforeverything.She’sveryunderstanding.TherewasnosupportorcomparabletowhatFUSEprovides
beforethis.”
-Carol,FUSEParticipant
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Frequent Users Systems Engagement: Washtenaw County, MI
“ThisprojectwassupportedbytheHealthResourcesandServicesAdministration(HRSA)oftheU.S.DepartmentofHealthandHumanServices(HHS)undercooperativeagreementnumber#U30CS26935,
TrainingandTechnicalAssistanceNationalCooperativeAgreement(NCA)for$325,000with0%ofthetotalNCAprojectfinancedwithnon-federalsources.Thisinformationorcontentandconclusionsarethoseof
theauthorandshouldnotbeconstruedastheofficialpositionorpolicyof,norshouldanyendorsementsbeinferredbyHRSA,HHSortheU.S.Government.”
