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MECKFUSEPILOTPROJECT

Process&OutcomeEvaluationFindings

September20,2017

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PREPARED BY:

Shelley Johnson Listwan, Ph.D. Principal Investigator

&

Ashleigh LaCourse, M.S. Research Assistant

Department of Criminal Justice & Criminology

University of North Carolina Charlotte

PREPARED FOR:

Mecklenburg County Community Support Services Department

FUNDING PROVIDED BY:

Mecklenburg County Community Support Services Department

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TABLE OF CONTENTS Acknowledgements 4 Executive Summary 5 Section I: Introduction 14 Section II: The Model 19 Section III: Process Evaluation: Implementation 22 Section IV: Process Evaluation: Participants 29 Section V: Outcome Evaluation 50 Section VI: Conclusions and Recommendations 76 Section VII: References 80 Appendix A. Profile by Interview Time 85

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ACKNOWLEDGEMENTS This study would not have been possible without the assistance of the many agencies

involved with this program. In particular, Marcus Boyd and his staff at the Urban Ministry

Center were an integral part of the data collection efforts. Their assistance with data

collection, coordination of interviews, and client tracking was invaluable. Caroline

Chambre and Liz Classen-Kelly provided crucial advice regarding system utilization data.

We would also like to thank the Community Support Services staff including Helen

Lipman, Stacy Lowry, Jamie Privuznak and Peter Safir for their dedication and patience

with the evaluation and data collection effort. Finally, we would like to acknowledge all of

the partners who assisted in data collection from the following agencies: Carolina Health

Systems, MEDIC, Men’s Shelter of Charlotte, Novant Health, Room in the Inn, and the

Salvation Army of Charlotte Center of Hope.

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EXECUTIVE SUMMARY

The Frequent Users Systems Engagement (FUSE) model targets high-frequency

users and directly addresses their complex needs through a stable housing and case

management program. FUSE seeks to improve the efficient use of public funds while

simultaneously enhancing outcomes for these targeted individuals. The FUSE model

follows a “housing-first” approach that offers permanent supportive housing without

preliminary requirements for rehabilitative participation and/or treatment. In contrast, the

“treatment-first” approach prioritizes rehabilitative treatment before entering into

permanent housing. The “housing-first” approach seeks to more effectively address long-

term homelessness and is becoming the dominant method in American communities

The Mecklenburg County FUSE Initiative (MeckFUSE) is a multi-agency program

aimed at reducing criminal recidivism and increasing housing stability for a high-risk

subset of the local chronically homeless population. MeckFUSE is funded by Mecklenburg

County and administered by the county’s Community Support Services Department.

Planning for the pilot program began in June 2012 and the Urban Ministry Center of

Charlotte was chosen as the contracted services provider in the spring of 2013. The first

client was housed in August 2013. Urban Ministry Center’s experienced staff of case

managers delivers all casework and client services.

The University of North Carolina Charlotte was contracted to provide the

evaluation of the program. This report summarizes implementation of the MeckFUSE pilot

project and details the population served and their outcomes across a four-year study

period. The process and outcome findings are summarized below.

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PROCESS EVALUATION: IMPLEMENTATION

To assess a program’s effectiveness, it is necessary to determine the logic of the

program and its fidelity to the original design. Within this broad objective, the study

examined the following research questions:

• Was the MeckFUSE program implemented as designed?

• Did the staff succeed in enhancing the coordination of services across systems? Do

service gaps remain? What lessons were learned during the implementation

process?

• How many clients were referred to the program each month? How many were

accepted? Of those who were accepted, how many were placed in homes?

• What are the characteristics of the clients involved in the MeckFUSE study?

• What are the shelter and criminal histories of clients involved in the MeckFUSE

study?

• What are the health profiles of the clients involved in the MeckFUSE study?

METHODOLOGY

The research team conducted face-to-face interviews with MeckFUSE participants

who consented to be part of the research study. The first 42 individuals accepted and housed

by the MeckFUSE program are included in the evaluation. Interviews occurred on a regular

basis from September 2013 to September 2016. Data for the process evaluation also

included interviews with stakeholders involved with the MeckFUSE program.

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RESULTS

Was the MeckFUSE program implemented as designed?

• The program was implemented as designed and reached an appropriate target

population.

• The MeckFUSE program has continued to serve approximately 45 clients using a

scattered site “Housing First” model.

Did the staff succeed in enhancing the coordination of services across systems? Do service gaps remain? What lessons were learned during the implementation process?

• The program leveraged a number of resources in the community and is supported

by a range of stakeholders.

• The program has developed a number of linkages in the community to serve needs

in the areas of transportation, medical, and behavioral health services.

• The program’s use of Master leases was a success, however, the issue of affordable

housing is a concern for the future.

How many clients were referred to the program each month? How many were accepted? Of those who were accepted, how many were placed in homes?

• The MeckFUSE program housed its first client in August 2013 and reached full

occupancy in July 2014.

• The program continues to serve approximately 45 clients at any given time;

although the evaluation focuses on the first group of clients served.

What are the characteristics of the clients involved in the MeckFUSE study?

• The typical client interviewed for the evaluation was 48 years old, African

American and male. Just over half of the participants had a high school degree of

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GED. None of the clients were married and the majority were unemployed at

admission into the program.

• The vast majority of participants were unable to meet their own basic needs

including transportation, housing, medical care, or food.

• The MeckFUSE program was designed to serve those individuals with chronic

arrest and shelter histories who also presented with behavioral issues. The data

support that the appropriate population was reach.

What are the shelter and criminal histories of clients involved in the MeckFUSE study?

• Given the eligibility criteria, the majority had long arrest and shelter histories.

• Nearly all (98%) MeckFUSE participants have an adult conviction record with a

mean of approximately 13 adult convictions.

• Over 90% of participants reported spending more than twelve months (lifetime

total) in a homeless shelter or other place not meant for habitation. Of those, the

mean time of homelessness is approximately 11 years.

What are the health profiles of the clients involved in the MeckFUSE study?

• A third of the clients rated their health as fair or poor.

• The majority reported a history of substance abuse and nearly half reported a mental

health diagnosis. Finally, the majority reported a high level of prior trauma

exposure and over half indicated a desire to have a better relationship with family.

OUTCOME EVALUATION

Outcome evaluations are designed to provide stakeholders with important information

regarding how well the program achieved its stated goals. With a program like MeckFUSE,

a number of outcomes are important. For the current study, three sets of outcomes are

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examined. The first set of outcomes examines whether the MeckFUSE program improved

client stability and/or reduced public service utilization (e.g., pre/post shelter, pre/post

hospital and ambulatory services). The second set of outcomes examines differences in

outcomes among those retained in the housing compared to those terminated. The third set

of outcomes examines MeckFUSE participant arrest rates compared to a similar group of

individuals who do not receive MeckFUSE housing or services. The study examined the

following research questions:

• Does participation in the MeckFUSE program improve stability among those

involved in the study at year 3 (e.g., improved functioning in areas such as

education, employment, relationships with family, use of alcohol or drugs, mental

health status, physical health, and trauma exposure)?

• Do the rates of shelter and emergency care utilization prior to MeckFUSE

involvement differ from the rates post involvement?

• What factors influence whether a participant will remain housed at the year 3

interview?

• Does retention in the MeckFUSE program reduce arrests?

• Did involvement in the MeckFUSE program impact arrest rates and shelter usage

when compared to those served through traditional avenues?

METHODOLOGY

System utilization data were collected from three sources. First, utilization data

from the local shelters post-entry into the MeckFUSE program were collected in early

2017. Second, billing information from the local hospitals were collected for clients three

years prior to their involvement in MeckFUSE and again approximately three years’ post-

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involvement in MeckFUSE. Third, ambulance transports and billing information were

collected by the Mecklenburg Emergency Management System Agency (MEDIC) for the

years 2012 through 2016. Finally, UNCC researchers collected recidivism data via the

Court Information Public Record System (CIPRS). CIPRS allowed researchers to collect

data from across the state from 1965 to 2017. Available data included infractions,

misdemeanors, and felonies, ranging in severity from traffic violations to serious crimes.

A quasi-experimental matched comparison group design was utilized to estimate

the impact of MeckFUSE involvement on two important outcomes: arrest and shelter

usage. The 42 MeckFUSE participants were matched to comparison group members based

on gender, age, race, and prior arrest record. The matching procedure produced a

comparison group of 42 individuals.

RESULTS

Does participation in the MeckFUSE program improve stability among those involved

in the study at year 3 (e.g., improved functioning in areas such as education,

employment, relationships with family, use of alcohol or drugs, mental health status,

physical health, and trauma exposure)?

• A majority of participants indicated that the MeckFUSE program had significantly

improved their lives and their relationships with their families.

• Participants were offered educational services when needed (e.g. GED classes for

those with a high school diploma). Nearly a fifth of the participants had improved

their educational level by the end of the study period.

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• Participants struggled with employment. The majority were unemployed and cited

a number of barriers to obtaining employment including criminal histories and

health issues.

• More participants were receiving SSI and SSDI benefits by the end of the study

period, which indicates a greater level of financial stability when compared to

panhandling or working odd jobs for income.

• Self-reported drug and alcohol use remained relatively stable across the evaluation

period.

• Over 40% of the participants indicated that their health was somewhat or much

better than the previous year, while only 7% indicated that their health declined.

This could in part be attributed to the work of MeckFUSE caseworkers who work

diligently to set up doctor’s appointments and Medicaid benefits for participants.

Do the rates of shelter and emergency care utilization prior to MeckFUSE involvement

differ from the rates post involvement? Were costs savings realized?

• MeckFUSE participants spent significantly fewer days in shelters post FUSE. In

particular, the participants spent an average of 278 days in shelters in the five years

pre FUSE. The same participants spent an average of 37 days in shelters in the three

years since MeckFUSE began.

• The average cost of shelter bed per day was estimated at $22.50. The costs incurred

by participants pre MeckFUSE was $160,964.1 The costs to shelters incurred by

1 This figure was calculated as the average shelter cost per day ($22.50) multiplied by the number of days spent in shelters by each participant over a five-year period prior to MekFUSE implementation.

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participants post MeckFUSE was $1,552.502. These figures represent a cost savings

of $159,411.50, which is the equivalent of nearly $4,000 per participant in cost

savings.

• From January 2012 – 2013, participants’ average ambulance service charges were

$4,758. Since entry into the program, (2013-2016) participants’ average charges

dropped to $3,639.

• Participant’s average hospital charges were $21,089 in the three years prior to

MeckFUSE implementation. Since entry into the program, average hospital charges

dropped to $12,007, a 43 percent reduction.

• Overall the MeckFUSE program was successful in reducing system utilization costs

among participants.

What factors influence whether a participant will remain housed at the year 3 interview?

• As of November 2016, 13 of the 42 clients interviewed for this study were

discharged from the MeckFUSE program.

• Those with a history of mental illness were less likely to be retained in MeckFUSE

study at the end of the study period. Of those with a history of mental illness, bipolar

disorder and schizophrenia were the most likely reported diagnosis.

Does retention in the MeckFUSE program reduce arrests?

• Fifty-two percent of MeckFUSE participants who completed the program were

arrested in the three years since entry into the program, while 77% of those who

were terminated from the program were arrested.

2 This figure was calculated as the average shelter cost per day ($22.50) multiplied by the number of days spent in shelters by each participant over a three-year period post entry into MeckFUSE housing.

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• Approximately 40% of participants who were retained in the program were arrested

multiple times since entry to the program (avg. 2 arrests), while almost 70% of

those who were terminated from the program were arrested more than once (avg. 9

arrests).

Did involvement in the MeckFUSE program impact arrest rates and shelter usage when

compared to those served through traditional avenues?

• Approximately 74% of the comparison group was arrested in the three years since

the MeckFUSE program began, compared to only 60% in the MeckFUSE program.

• Comparison group members were arrested much more quickly than MeckFUSE

participants (average 5 months vs. 15 months).

• Participation in MeckFUSE, age, and number of arrests prior to MeckFUSE were

significant predictors of arrest. Those who received MeckFUSE services, were

older, and had fewer arrests prior to MeckFUSE were less likely to be arrested

during the follow-up period.

• Finally, shelter utilization among comparison group and participants were

collected. The MeckFUSE participants averaged 37 days of shelter utilization in

the three years post FUSE compared to an average of 72.5 days of shelter use

incurred by the comparison group during the same time period.

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SECTION I: INTRODUCTION

Since the early 1970s, the number of people under correctional surveillance has

increased seven-fold, with daily counts reaching over 2.2 million behind bars and nearly 5

million on probation or parole (Harrison & Beck, 2006; Sabol, Couture, & Harrison, 2007).

It is estimated that one in every 100 adults and one in every nine African American men

ages 20 to 34 is incarcerated (Warren, 2008). During the get tough movement, mental

illness was criminalized and local jails often became the first response and, in some cases,

de facto mental institutions. Many of these individuals have a history of chronic offending,

homelessness, and trauma exposure.

In spite of this punitive culture, there is now 25 years of evidence showing that that

the American public strongly endorses the correctional goal of rehabilitating offenders

(Cullen & Gendreau, 2000). In a 2001 national survey, 55 percent of Americans stated that

rehabilitation should be the “main emphasis” of prisons (Cullen, Pealer, Fisher, Applegate,

& Santana, 2002, p. 136). Further, 88 percent agreed that “it is important to try to

rehabilitate adults who have committed crimes and are now in the correctional system”

(Cullen et al., 2002, p. 137). However, with the growing cost of prison and increasing

effectiveness of community-based treatment, many jurisdictions are supporting

community-based options. The chronic overuse of public services such as jails, homeless

shelters, and hospital emergency departments is more likely to occur among the chronically

homeless who concurrently have behavioral diagnoses or mental health conditions (Hickert

& Taylor, 2011; Russolillo, Patterson, McCandless, Moniruzzaman, & Somers, 2014). In

response, the Corporation for Supportive Housing (CSH) has developed a model centered

on supportive housing that has been piloted in a number of cities across the country. The

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Frequent Users Systems Engagement (FUSE) model targets high-frequency users and

directly addresses their complex needs through a stable housing and case management

program. FUSE seeks to improve the efficient use of public funds while simultaneously

enhancing outcomes for these targeted individuals.

Communities face exorbitant costs when their chronically homeless populations

continually cycle through jails, shelters, and hospitals (Kertesz & Weiner, 2009).

Numerous approaches have been employed to curb the over-use of such services but

traditional approaches, such as social housing projects, have yielded little (Fallis, 2010),

leading to a reimagining of the social support paradigm for this unique population.

Recently, permanent supportive housing initiatives have been established in urban areas

facing the challenges of chronic homelessness.

The FUSE model follows a “housing-first” approach that offers permanent

supportive housing without preliminary requirements for rehabilitative participation and/or

treatment. In contrast, the “treatment-first” approach prioritizes rehabilitative treatment

before entering into permanent housing. The “housing-first” approach seeks to more

effectively address long-term homelessness and is becoming the dominant method in

American communities (Henwood, Cabassa, Craig, & Padgett, 2013; Henwood, Stanhope,

& Padgett, 2011). It is seen as an effective approach in the quest to end chronic

homelessness, improve service access, and decrease personal vulnerability (Henwood et

al., 2013; Owczarzak, Dickson-Gomez, Convey, & Weeks, 2013). Quantitative and

qualitative evaluations of “housing-first” programs have, thus far, shown promising results.

FUSE programs established in metropolitan areas have shown early potential. New

York City saw 91 percent of its program participants remain in permanent housing after

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one year, and 86 percent after two years (Aidala, McAllister, Yomogida, & Shubert, 2013).

Evaluators also noted a significant reduction in jail stays, psychiatric inpatient stays, illicit

drug use, and ambulance usage. New York City’s program has been shown to be cost-

effective over the first two years of operation with per-person cost savings estimated at

$15,680 per year (offsetting 60 percent of total public investment in the program) (Aidala

et al., 2013).

Further “housing-first” initiatives have yielded positive results as well. After

following 4,679 individuals placed in supportive housing in New York City, evaluators

noted a service usage reduction of $16,281 per housing unit per year (Culhane, Metraux,

& Hadley, 2002).3 A similar evaluation in Seattle-King County, Washington revealed a

significant savings of $36,579 per person per year, resulting in a net program savings of

approximately $18,000 per person per year (Srebnik, Connor, & Sylla, 2013).4 The Seattle

Housing First Study revealed significant cost savings related to health care and criminal

justice services in conjunction with increased housing stability, with approximately two-

thirds of participants remaining in housing after the first year (Kertesz et al., 2009).

Additionally, a “housing-first” approach in the city of San Mateo, California resulted in a

remarkable reduction in service costs in a cost-effective manner (Greenberg, Korb, Cronon,

& Anderson, 2013).

In San Francisco, California, program evaluators found that 81 percent of clients

remained in housing for at least one year (Martinez & Burt, 2006). The program also

produced positive results concerning health care usage. The percentage of clients with an

3Program costs were estimated at $17,277 per housing unit per year, yielding a net cost of $995 per housing unit per year over the first two program years (Culhane et al., 2002). 4 Program costs were estimated at approximately $18,600 per person per year (Srebnik et al., 2013).

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emergency department visit decreased from 53 percent to 37 percent, the average number

of visits decreased from 1.94 to 0.86, and the total number of emergency department visits

decreased by 56 percent (from 457 to 202). Additionally, the supportive housing program

reduced the likelihood of in-patient hospital admission (19 percent to 11 percent) (Martinez

& Burt, 2006).

Other studies have highlighted the positive impacts of the “housing-first” approach.

Hickert and Taylor (2011) reported a significant reduction in the use of jails and substance

abuse treatment centers, and increased income, nutritional access, and housing stability for

102 clients. Another study of three separate “housing-first” programs found that of 80

participants, 84 percent remained in their respective program for at least one year while

one-half spent every night in their housing unit (Pearson, Montgomery, & Locke, 2009).

Qualitative research conducted in Los Angeles, California has revealed that,

although participants are generally optimistic of their situation, the role of the

neighborhood plays a large part in the positive programmatic experience (Henwood et al.,

2013). Levitt and colleagues (2012) drew a distinction between the chronically street

homeless and long-term shelter stayer populations. In their mixed-methods study,

researchers found that the chronically street homeless participants required more program

resources, including psychiatric and health care services, financial assistance, and general

housing assistance. Similarly, Montgomery, Hill, Kane, and Culhane (2013) focused their

attention on veterans. Comparing “housing-first” participants to those of a “treatment-first”

program, the researchers found that time-to-housing was reduced from 223 to 35 days.

Additionally, health care and emergency department service usage was significantly

reduced in the “housing-first” group, versus the “treatment-first” group.

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From the perspective of the providers working within “housing-first” or “treatment-

first” programs, client goals are prioritized based upon the very programmatic environment

that has been established. After interviewing program workers, Henwood and colleagues

(2011) noted that, ironically, “housing-first” workers focused more on service provision

and treatment, while “treatment-first” workers spent most of their time searching for

appropriate housing options. This surprising finding is likely due to the fact that “housing-

first” workers are able to focus on treatment because the population has already secured

stable housing. It has been noted that the most helpful services include financial counseling,

job training, and leadership skills (Washington, 2002). Overall, multiple evaluations of

“housing-first” programs suggest that even those whom society has deemed unrecoverable

can successfully maintain long-term housing stability (McNaughton Nicholls & Atherton,

2011).

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SECTION II: THE MODEL FUSE: FREQUENT USER SYSTEMS ENGAGEMENT

The FUSE model was developed by the Corporation for Supportive Housing

(CSH), an organization focused on advancing solutions that use housing as a platform for

services. The FUSE model employs three central “pillars” to address high-frequency users

of homeless shelters, jails, and other crisis service assistance. The goal of increased housing

stability, reduced criminal recidivism, and reduced crisis service utilization is realized

through 1) data-driven problem solving, 2) policy and systems reform, and 3) targeted

housing and services (CSH, 2011). Currently, the FUSE model is being implemented in 25

communities across the United States.

Source: Corporation for Supportive Housing, Blueprint for FUSE, 2011.

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The Mecklenburg County FUSE Initiative (MeckFUSE) is a multi-agency program

aimed at reducing criminal recidivism and increasing housing stability for a high-risk

subset of the local chronically homeless population. As noted above, the FUSE model has

been implemented in a variety of jurisdictions across the nation; however, each site is

unique in terms of its specific population served and services rendered. In August 2012,

stakeholders with the MeckFUSE program outlined a justification for moving forward with

a FUSE model in the county. The arguments included:

• A 2012 study on the jail population in Mecklenburg County revealed that nearly all chronic offenders, persons arrested and jailed more than four times in year, were known mentally ill and homeless persons. This group accounted for more than 21,000 bed days over a four-year period at a cost of 2.5 million dollars. This study illustrated that a relatively small group of individuals consume a disproportionate amount of public resources due to their high risk and needs.

• In the 2012 Criminal Justice Survey, a vast majority of Mecklenburg County residents favored non-jail options for the homeless and mentally ill.

• The services being proposed did not exist currently in the county. For example,

while other agencies such as Recovery Solutions provide stabilization and housing services to those with mental illness in an effort to divert them from the criminal justice system, the target population for the proposed FUSE program would have different admission requirements and broaden the use of community resources and providers. The MeckFUSE model is considered part of the jail diversion continuum.

• Evaluation findings of the FUSE model in NYC indicated a 91% participant

retention rate after one year coupled with a decrease in jail, shelter, and hospital stays. The model has the potential to break the costly cycle of incarceration, homelessness, and emergency service utilization common to high risk and needs individuals.

The county partnered with the Corporation for Supportive Housing (CSH) to

implement the pilot project. The agency has provided technical assistance to numerous

agencies across the county in developing this model. The agency provides technical

assistance in three broad areas: design (e.g., program eligibility), implementation

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(developing community infrastructure, service delivery), and training. The agency was

involved with MeckFUSE program from November 2012 until December 2014.

MeckFUSE is funded by Mecklenburg County and administered by the county’s

Community Support Services Department. This funding model is noteworthy given it is

distinct from typical funding sources of supporting housing (e.g., HUD). Planning for the

pilot program began in June 2012 and the Urban Ministry Center of Charlotte was chosen

as the contracted services provider in the spring of 2013. The first client was housed in

August 2013. Urban Ministry Center’s experienced staff of case managers delivers all

casework and client services.5 The University of North Carolina Charlotte was contracted

to provide the evaluation of the program. This report summarizes implementation of the

MeckFUSE pilot project and details the population served and their outcomes across a

four-year study period.

5Although access to supportive services are both offered and encouraged, clients are not required to participate as a condition of the program.

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SECTION III: PROCESS EVALUATION: IMPLEMENTATION

To assess a program’s effectiveness, it is necessary to determine the logic of the

program and its fidelity to the original design. Within this broad objective, the current study

examines the following research questions:

• Was the MeckFUSE program implemented as designed?

• Did the staff succeed in enhancing the coordination of services across systems? Do

service gaps remain? What lessons were learned during the implementation

process?

• How many clients were referred to the program each month? How many were

accepted? Of those who were accepted, how many were placed in homes?

METHODOLOGY

The data for the current section was collected from several sources. First, the

principal investigator interviewed stakeholders and attended stakeholder meetings

throughout the four-year study. Meetings occurred on a monthly basis during the planning

and implementation phase of the project. Once the MeckFUSE program was fairly well

established the stakeholder meetings were scaled back to quarterly meetings. The number

of clients referred, accepted, and placed were collected by the Urban Ministry Center6 staff

and shared with the principal investigator.

6The contractor selected to oversee the project and provide case management services to the clients.

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RESULTS

Stakeholders

An important component of the FUSE model is leveraging community resources

and creating partnerships. To that end, a number of agencies were invited to attend planning

sessions to develop the eventual MeckFUSE model. Those agencies included the Office of

Criminal Justice Services, the Public Defender’s office, Urban Ministry Center, the Men’s

Shelter of Charlotte, the Salvation Army Center of Hope for Women and Children,

Provided Services Organization, Social Services, Legal Services of Southern Piedmont,

McLeod Center, Supportive Housing Communities, A Place to Live Again, the Veteran’s

Administration, Carolinas Health Care, Charlotte Mecklenburg Police Department, and the

Hoskins Park Ministries.

Eligibility Criteria

Eligibility criteria for the program evolved after a number of meetings. Given that

the program wished to target those clients who were more likely to over-utilize public

resources (e.g., jails, shelters, and hospitals), the target population included a measure of

chronicity. At the same time, however, there were discussions that the people targeted

must also be eligible to live independently and not have a history of charges (e.g., sex

offenses) that could violate apartment complex rules. It was also determined that

undocumented immigrants would be excluded from the intervention.

The initial list of potentially eligible clients came from the Homeless Management

Information System created by Bell Data Systems, Inc. This system tracked shelter usage

within the county.7 In order to capture jail utilization, meeting with the stakeholders from

7In 2012, Mecklenburg County began utilizing the statewide homeless information report system referred to as Carolina Homeless Information Network (CHIN).

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the jail indicated that their automated data system could capture clients who were

incarcerated in jail on multiple occasions. While the agency collects data on every person

who comes into jail, it was determined that their measure of homelessness was self-

reported and may not be fully reliable. As such, it was determined that shelter data and jail

data would be collected and matched to determine the list of eligible clients. The

stakeholders agreed the frequency of jail and shelter stays would include four shelter stays

and four jail episodes within a five-year window (December 1, 2007 – November 30, 2012)

with at least one jail episode and one shelter episode occurring within 2012. The last

criteria were added to increase the likelihood that a client may be more likely to be currently

homeless and/or residing in the area.

Beyond over-utilization of resources, the stakeholders decided that participants

targeted would likely have a behavioral and/or mental health condition. The planning team

decided that clients with a serious and persistent mental illness could be included and

clients with a behavioral diagnosis such as substance abuse would also be eligible. It was

determined that the agency responsible for recruitment (Urban Ministry Center) would

need to screen clients for mental health and behavioral issues. As such, individuals were

chosen for inclusion based upon six criteria:

1. Four or more jail admissions within the last five years

2. Four or more homeless shelter admissions within the last five years

3. Homeless/without a permanent residence

4. Ability to live and manage an apartment, independently

5. United State resident or legal resident

6. Indicator of a mental health or behavioral health problem

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Additionally, exclusionary criteria included the following:

1. Subject to lifetime registration requirements under a State sex offender

registration program

2. Conviction of manufacturing/producing methamphetamine on the premises

of any federally-assisted housing

3. Conviction of arson within the past three years

4. Other factors that may be considered by MeckFUSE officials

Once compiled, the Urban Ministry Center performed in-reach to local jail and

homeless shelter facilities. Caseworkers also performed out-reach to individuals living on

the street.

Outreach & Recruitment

Utilizing the data procedures outlined above, a list of 193 eligible clients was

identified for the MeckFUSE program. Of those, 156 were men and 37 were women.

Table 1 illustrates the basic background of the clients by gender.

Table 1. Characteristics of Those Deemed Eligible for the MeckFUSE Program (n = 193) Variable Men Women Average Age 44 37 Percent African American 73% 72% Number of Shelter Episodes 14 7 Number of Jail Episodes 12 10

In July 2013, the Urban Ministry Center staff members began outreach services to

individuals on the list to assess their eligibility and willingness to participate in the

MeckFUSE program. MeckFUSE case managers began visiting the shelters and jails to

interview clients. The clients were all assessed with a screening tool that measured previous

housing history, mental health and substance abuse, and general risk and needs. The

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MeckFUSE team regularly met to discuss placements and if the team and client remained

interested, the client was accepted into the program and the team began to work on housing

options. In most cases, the client would be given the opportunity to preview the apartment

before final placement decisions were made. Once the client agreed, the application process

continued with the Urban Ministry Center staff working with the landlords to arrange for

a housing inspection and make any necessary repairs. Once the lease was signed, the staff

would begin working with agencies for furniture and assisting the client with moving into

the rental property.

Housing

The County decided that Urban Ministry Center would operate a master lease

option for the tenants where they would be listed as the lease holder. This option works

well given the landlords of the apartment complexes feel more confident about leasing to

clients, some of who do not have quality lending backgrounds. As a scattered-site initiative,

MeckFUSE participants were housed in multiple areas throughout the city of Charlotte;

however, there are a few clusters of participants residing in the same apartment complex.

Participants were assigned their own unit and do not share living space with any other

MeckFUSE client. The Urban Ministry Center staff developed a number of relationships

with community providers to assist with the apartments (e.g., Crisis Assistance Ministry

assists with furniture and paying the deposits).

The first five clients were housed in August 2013. The planning team felt it might

be possible to recruit the full 45 clients they originally hoped to target by the beginning of

2014. However, it became clear by December 2013 that the original list of 156 men and

37 women was unlikely to produce a sufficient number of eligible clients. As illustrated

27

in Figure 1, the number of individuals screened for the program dropped off significantly

by the end of 2013. The primary issue in this regard was the inability to locate many of the

people on the list. As of December 2013, the various outreach and in-reach procedures

allowed the Urban Ministry Center staff to contact and screen 75 clients for the program.

Of those, 25 were housed, 5 were waiting to be given a move-in date, 36 were not offered

placement, and 9 indicated that they were not interested in participating in the program.

The vast majority of the remaining clients on the list, approximately 118, could not be

located through the various in reach procedures.

While the staff at the Urban Ministry Center indicated that they would continue their

outreach, it was decided that the list should be augmented with a new sample of clients.

This new list was created by extending the time frame of the original sample by 12 months

Figure1.Numberofindividualsscreened&rejectedbymonth

July2013– July2014(n=75)

July Aug Sept Oct Nov Dec Jan Feb Mar April May June JulyScreened 16 24 12 9 4 3 2 1 10 13 13 2 4Rejected 4 9 6 5 4 2 1 1 5 4 6 0 0

0

5

10

15

20

25

30

28

to November 30, 2013. The newer CHIN database was utilized for this task. In addition,

efforts were made to engage street homeless clients who fit the criteria but were more

difficult to reach. The refreshed list produced 130 additional individuals (109 men and 21

women). The refreshed list provided a sufficient number of clients for the program. By July

2014 the program reached capacity with 45 individuals. Figure 2 illustrates the number of

clients housed by month.

Figure2.NumberofMeckFUSE participantshousedbymonth

July2013- July2014 (n=45)

0

5

8

3

7

4

12

12

3

54

July Aug Sept Oct Nov Dec Jan Feb Mar April May June July

Housed

29

SECTION IV: PROCESS EVALUATION: PARTICIPANTS

In addition to assessing the implementation of the program, a process evaluation

should provide a description of clients screened and served by the program during the

implementation phase. Within that context, the current report examines the following

research issues:

• What are the characteristics of the clients involved in the MeckFUSE study?

• What are the shelter and criminal histories of clients involved in the MeckFUSE

study?

• What are the health profiles of the clients involved in the MeckFUSE study?

METHODOLOGY

Data Collection

The research team conducted face-to-face interviews with MeckFUSE participants

who consented to be part of the research study. It was proposed that the research study

would be limited to the first 45 individuals accepted and housed by the MeckFUSE

program. The research staff contacted each participant to schedule the first interview. The

first interviews were timed to occur within approximately 1 month of housing placement

(Time 1). The second interview was timed to occur one year later (Time 2). The third

interview was time to occur one year after the Time 2 interviews (Time 3). Interviews

occurred on a regular basis from September 2013 to September 2016. At each interview,

potential participants were informed that there would be no legal benefits, nor any legal

repercussions, derived from their participation. Additionally, they were informed that their

30

participatory status in the MeckFUSE program would not be affected by their decision to

participatel in the interview process.

Of the 45 clients placed in housing, one person refused to participate in the research

study and two people were discharged as unsuccessful and exited the program before

interviews could be completed (n = 42). Year 2 interviews were conducted with each

person 12 months after the first interview. Ten individuals were terminated before their

interviews could be scheduled (Time 2, n = 32). Finally, Year 3 interviews were conducted

with each person approximately 12 months after the second interview. Four individuals

were terminated before the interview could be scheduled (Time 3, n = 28).

Interviews were designed to highlight the experiences and perceptions of newly

placed MeckFUSE participants. Each face-to-face interview lasted approximately one

hour. Participants were provided with a monetary incentive. Those who consented to a

face-to-face interview were given a $25 Wal-Mart gift card at each interview regardless of

whether the interview was completed. Only one client did not complete the full interview.

A gift card receipt was signed by both the participant and interviewer and copies kept by

both parties.

All three interview sessions were guided by an interview questionnaire.

Interviewers were instructed to assess the literacy and competency of each consenting

participant while progressing through the interview packet. As a result of the repetitious

nature of the standardized questions, response category cards were provided for interview

participants. These pre-printed cards were included in each interview packet and

interviewers were asked to allow the participant to read and review each card as the

interviewer read the corresponding questions. This process allowed the interviewers to use

31

their time more effectively and also seemed to increase the comfort level of the participants.

The interview questionnaire asked clients to provide further details about particular issues

(e.g., what employment struggles have you experienced). Where relevant the results of

these open-ended questions are provided in the form of italicized quotes throughout this

report.

The principal investigator recruited and trained a total of ten interviewers. All

interviewers were graduate students at the University of North Carolina at Charlotte. The

research team initially contacted each MeckFUSE participant and, if verbal consent was

provided, an interview was scheduled based on interviewer availability. Due to safety

concerns, each interviewer was trained to allow for a quick egress, prohibiting an

interviewee to position himself/herself between the interviewer and a viable exit.

Interviewers were informed that if they felt uncomfortable at any time they could terminate

the interview. No interviews were terminated early during this study period.

RESULTS

Demographics

The following results provide the profile of clients involved in the research study

at Time 1 (n = 42). The profile of clients at Time 2 and Time 3 can be found in Appendix

A. As indicated in Table 2, the clients’ ages range from 25 to 61 years, with a mean age

of 48 years. With regards to gender, 86% participants are male and 78% participants

identify as African-American. Educationally, 48% have at least a high school/GED level

of education and three (7%) participants have a history of military service.

32

Table 2: Participant Demographics Variable N % AGE 18-24 0 0.0 25-34 4 9.5 35-44 9 21.4 45-54 20 47.6 55-64 9 21.4 65 and Over 0 0.0 GENDER Male 36 85.7 Female 6 14.3 RACE Caucasian 6 14.3 African-American 33 78.6 American Indian 1 2.4 Other 2 4.8 ETHNICITY Non-Hispanic 39 92.9 Hispanic 3 7.1 EDUCATION <High School/GED 22 52.4 High School/GED 14 33.3 >High School/GED 6 14.3 MILITARY SERVICE Yes 3 7.1 No 37 88.1

As noted in Table 3, none of the MeckFUSE participants were married at the time

of the interview. Half of the participants have at least one child, however, none of the

participants have children currently residing with them. The majority of participants were

unemployed at the time they began participating in the program. Finally, a majority of

participants (76.2%) identify as religious. Of those who identify as religious, 75% regularly

attend religious services and 90.6% participants state that they pray regularly.

33

Table 3: Participant Demographics & Religiosity Variable N % MARITAL STATUS Married 0 0.0 Single 30 71.4 Separated 4 9.5 Divorced 8 19.0 EMPLOYED Yes 10 23.8 No 32 76.2 RELIGIOUS** Yes 32 76.2 No 9 21.4 ATTEND SERVICES Yes 24 57.1 No 8 19.0 N/A 10 23.8 PRAYS REGULARLY Yes 29 69.0 No 3 7.1 N/A 10 23.8

**One missing response

Criminal History

As discussed, eligibility was determined in part by an individual’s chronic jail

incarceration history over a 5-year period. During the interview, participants were also

asked to report their lifetime arrest and incarceration history. According to the clients, 42%

were arrested before the age of 18 and half of those served time in a juvenile detention

center. The mean number of juvenile arrests was 2.7 with a mean age upon first arrest of

13.8 years. Nearly all (98%) MeckFUSE participants have an adult conviction record with

a mean of approximately 13 adult convictions (although seven respondents did not know

the number of convictions). A third of the participants have a history of violent crime.

Perhaps not surprising given the inclusion criteria, 36% of the participants stated they had

been arrested in the past six months, with 17% having charges pending in the court system.

34

Table 4: Participant Criminal Justice System History Variable N % JUVENILE ARREST Yes 18 42.9 No 24 57.1 ADULT CONVICTION Yes 41 97.6 No 1 2.4 ARREST in <6Months Yes 15 35.7 No 27 64.3 CHARGES CURRENTLY PENDING

Yes 7 16.7 No 35 83.3 HISTORY OF VIOLENCE

Yes 13 31.0 No 29 69.0

Shelter History

Most MeckFUSE participants (93%) spent more than twelve months (lifetime total)

in a homeless shelter or other place not meant for habitation. Of those, the mean time of

homelessness is approximately 11 years (two respondents did not know their total length

of homelessness). As seen in Figure 3, when contacted by a FUSE caseworker, 50% were

living on the street or a public place, 36% were in a homeless shelter, and 10% were in jail

or prison. In the past, 43% participants report being a primary leaseholder of a

house/apartment; however, only 12% participants report owning a house/apartment.

Figure 3 further reinforces these results with 75% indicating they lived on the streets or the

shelter in the year preceding the study.

35

Table 5: Participant History of Homelessness Variable N % TOTAL TIME IN SHELTER

3-5 Months 2 4.8 6-11 Months 1 2.4 >12 Months 39 92.9 EVER LEASED HOME Yes 18 42.9 No 24 57.1 EVER OWNED HOME Yes 5 11.9 No 37 88.1

Figure 4 further illustrates the needs of clients. By nearly every indicator, three

quarters of the participants had a difficult time meeting basic needs. To that end, it appears

that MeckFUSE has succeeded in accepting the appropriate target population.

Figure3.Participant’sLivingSituationPriortoMeckFUSE

50

35.7

92.4 2.4

0

10

20

30

40

50

60

70

Street Shelter Jail Hotel Friend

36

MeckFUSE Housing

Given clients were housed at the time of the first interview, they were asked to rate

their current MeckFUSE supported housing and whether they contributed towards the rent.

All of the participants rate their current housing as “good,” “very good,” or “excellent.” A

third of the participants were currently paying some portion of their rent. Of those

respondents contributing towards rent, the mean rent portion is $197.64. To pay their

portion of the rent, 62% of participants were using SSDI/SSI benefits and 39% were using

income from employment earnings.

Figure4Participantsunabletomeetbasicneeds

priortoMeckFUSE

78 81 81

72 69

78 81

69

78

30

40

50

60

70

80

90

37

Table 6: Participant Current MeckFUSE Housing Information Variable N % RATING OF APT Very Poor 0 0.0 Poor 0 0.0 Fair 0 0.0 Good 10 23.8 Very Good 11 26.2 Excellent 21 50.0 PAYING SOME RENT Yes 13 31.0 No 29 69.0 SOURCE OF MONEY SSDI 6 14.3 Earnings 5 11.9 SSI 2 4.8 N/A 29 69.0

Furthermore, as illustrated in Figure 5, 91% of participants rate their current

neighborhood as “safe” or “very safe” while only 2 (5%) participants rate their

neighborhood as “dangerous.”

Figure5.Participant’sratingsofcurrentMeckFUSE housing

04.8

76.2

4.50

102030405060708090

100

VeryDangerous Dangerous Safe VerySafe

38

Client Needs

The clients targeted by the MeckFUSE program have a myriad of needs. Clients

were asked a variety of questions about their physical health, mental health, and needs.

With regards to their physical health needs, the majority of the participants (57%) rated

their health as “good,” “very good,” or “excellent,” whereas 14% participants rate their

health as “poor” or “very poor.” Over a quarter of the participant’s report that they

experience daily bodily pain that is “severe” or “very severe.” Of those suffering daily pain,

a third claimed that their bodily pain interferes with daily activities “quite a bit” or

“extremely.” As shown in figure 6, the most common medical condition is high blood

pressure (24%), followed by high cholesterol (14%), and hepatitis C (14%).

Table 7: Participant Physical Health Status Variable N % HEALTH RATING Very Poor 1 2.4 Poor 5 11.9 Fair 12 28.6 Good 9 21.4 Very Good 5 11.9 Excellent 10 23.8 DAILY PAIN None 18 42.9 Very Mild 6 14.3 Mild 1 2.4 Moderate 5 11.9 Severe 7 16.7 Very Severe 5 11.9 DOES PAIN INTERFERE? Not At All 11 26.2 A Little Bit 2 4.8 Moderately 3 7.1 Quite A Bit 2 4.8 Extremely 6 14.3 N/A 18 42.9

39

Clients were also asked to self-report whether they utilized hospital services. Over

a quarter of the participants reported that they had utilized hospital services at least once in

the past six months and 17% summoned an ambulance for treatment and/or transport. Of

those who used the hospital, the mean number of hospital visits in the past six months is

four. Of those who utilized an ambulance in the past six months, the mean number of 9-1-

1 calls was one. Of those who used the hospital, 67% used the former local public hospital

(Carolinas Medical Center) while 17% used the local private hospital (Presbyterian). Of

the 12 participants who were treated at a hospital, 92% said they received a bill, with only

one participant able to pay.

Figure6.Participants’selfreportedhealthconcerns

24

14 1410

75 5 5 5

2 2

0

5

10

15

20

25

30

40

Table 8: Participant Self-Reported Health System Usage Variable N % HOSPITAL in <6Months Yes 12 28.6 No 30 71.4 AMBULANCE in <6Months

Yes 7 16.7 No 35 83.3 RECEIVED GOOD CARE

Yes 13 31.0 No 0 0.0 N/A 28 66.7 RECEIVED BILL Yes 11 26.2 No 2 4.8 Don’t Know 1 2.4 N/A 28 66.7 PAID BILL Yes 1 2.4 No 10 23.8 N/A 31 73.8

Participants were also asked to indicate whether they had been diagnosed with a

mental illness. Nearly half of the clients reported at least one mental health diagnosis, with

14% reporting multiple diagnoses. As seen in Figure 7, the most common primary self-

reported diagnoses were bipolar disorder and schizophrenia.

41

Clients targeted for this program could present with a mental illness and/or a

behavioral health diagnosis. The behavioral health issue most commonly identified was

substance abuse. In fact, 91% of participants reported a history of substance abuse. The

majority of those with a history of drug use indicated that they preferred cocaine or crack.

With regards to current use, 24% report ongoing substance abuse with 31% of those

participants stating that they could benefit from help in this area.

Participants were asked to report whether their prior drug and alcohol use had an

impact on their relationships with family and friends. They noted: “absolutely, especially

family it created distance in relationships,” “caused difficulties, legally and health-wise,

had alcohol induced depression,” “family arguments and fights with children,” “skipped

school and couldn't hold a job,” “I drank to feel good. That is one of the reasons that I

Figure7.Percentagewithselfreportedprimary

mentalhealthdiagnosis

33.3 33.3

22.2

5.5 5.5

0

10

20

30

40

50

Bipolar Schizoph Depression PTSD Anxiety

42

became homeless. I always wanted my next fix. It caused me to commit crime,” and one

person reported, “maybe, I am not sure. I don't care much about it if it did.”

Table 9: Participant Mental Health & Substance Use Status Variable N % Mental Health History Yes 18 42.9 No 24 57.1 Past Substance Abuse Yes-Alcohol 14 33.3 Yes-Drugs 6 14.3 Yes-Both 18 42.9 No 4 9.5 Current Substance Abuse Yes-Alcohol 9 21.4 Yes-Drugs 1 2.4 Yes-Both 0 0.0 No 31 73.8 Would Like Help Yes 13 31.0 No 25 59.5 N/A 4 9.5

Finally, the clients’ risk and need level was measured by the Level of Service

Inventory-Revised (LSI-R). The LSI-R is a 54 item risk and needs assessment that

measures factors across ten different domains known to be related to criminal behavior,

including criminal history, education and employment, financial circumstances, family and

marital situation, accommodations or housing, leisure and recreation, companions, drug

and alcohol abuse, emotional and personal characteristics, and attitudes and orientations.

Scores on the assessment range from 0 to 54 with higher scores representing an increased

likelihood of recidivism. The LSI-R has been found to be a valid predictor of recidivism

(Andrews & Bonta, 1995; Gendreau, Little & Goggin, 1996; Flores et al., 2006) across

gender1 (Lowenkamp, Holsinger & Latessa, 2001) and race and ethnicity (Holsinger,

43

Lowenkamp & Latessa, 2004; Schlager & Simourd, 2007). It has also been validated for

violent offenders (Simourd & Malcom, 1998) and drug offenders (Kelly & Welsh, 2008).

The LSI-R score was collapsed into 5 categories: low (0 – 13), low/moderate (14 –

23), moderate (24 – 33), moderate/high (34-40), and high (41+). The developers have

identified the categories as predictive of recidivism with higher scores correlating with

higher risk or probability of recidivism. Given most of the factors are dynamic in nature

(e.g., substance addiction, family problems, employment status), it would be expected that

as clients are given services directed towards their needs, their overall score and risk of

recidivism would decrease. Figure 8, illustrates that the average LSI-R score among all 42

participants was 28, which fall into the moderate risk category. In fact, 76% of the

participants fall into the moderate risk category. It is encouraging to see that no clients fell

into the lowest risk category, because these individuals should be excluded from intensive

treatment efforts given their low probability of recidivism.

44

Trauma Exposure

We measured the participant’s exposure to violence in the last 6 months and/or

ever. Victimization research suggests that individuals who either witness or are direct

victims of violence are substantially more likely to experience long-term negative

outcomes such as anxiety, depression, PTSD, and health-related concerns (Briere & Jordan,

2004; Campbell, 2002; Flannery, Singer, & Wester, 2001; Flannery, Singer, Van Dulmen,

Kretschmar, & Belliston, 2007; Gavranidou & Rosner, 2003; Koss, Bailey, Yuan, Herrera,

& Lichter, 2003; Lang et al., 2003). Research on victimization shows that persons who

experience more than one type of victimization, known as poly-victims, are at greater risk

of experiencing negative outcomes than those who experience only one type of

victimization (Finkelhor, et al., 2007, 2009; Ford, Elhai, Connor, & Frueh, 2010; Snyder,

Figure8.RiskofRecidivism

0102030405060708090

Low Low/Mod Moderate Mod/High High

MeanRiskScore:28

45

Fisher, Scherer, & Daigle, 2012) or multiple incidents of the same type of victimization

(Turner, Finkelhor, & Ormrod, 2010). In fact, in one study of poly-victimization, it was

found that including “poly-victimization in the analyses either eliminated or greatly

reduced the predictive power of individual types of victimization” on trauma symptoms

(Finkelhor et al., 2007, p. 18).

As such, clients were asked to report whether they had been exposed to a variety of

violent events. Specially, they were asked to indicate whether they had been exposed to the

following list of 16 events: serious accident or fire at home or at job; natural disaster like

hurricane, earthquake, or tornado; direct combat experience in a war; physical assault as

adult by your partner; physical assault by another besides partner; physical assault as a

child; witnessing people hit one another in family growing up; sexual assault or rape as a

child or teenager; sexual assault or rape in your adult life; witnessing physical assault of

another; witnessing sexual assault of another; witnessing a violent death of another

person; losing a child through death; loss of a parent before age 18; loss of spouse, partner

as an adult; or any other terrible or frightening event.

Ninety percent of the participants reported experiencing or witnessing at least one

form of violence. Figure 9 illustrates the most frequently reported forms of violence

exposure. In addition, we examined the number of people who were exposed to more than

one form of violence or who were poly-victims. It is worth noting that each person who

reported being exposed to a traumatic event reported being exposed to at least 2 traumatic

events, with 4 being the mean number of traumatic events witnessed among participants.

46

Social Support

Many researchers suggest that social support creates a buffer against the effects of

stressful and traumatic events (Cohen & Wills, 1985; Cummins, 1988). Social support can

help reduce strain, lessen subsequent negative emotions, and produce higher levels of self-

control and environmental stability (Cullen, 1994; Cullen, Wright, & Chamlin, 1999).

Scarpa and colleagues have found in numerous studies that individuals who are exposed to

community violence but who have poor coping skills and low levels of perceived social

support are significantly more likely to experience PTSD symptoms, depression, and

aggressive behavior outcomes (Haden & Scarpa, 2008; Scarpa, 2003; Scarpa & Haden,

Figure9.Participantswhoexperienced

traumaticeventsbytype

33.3

38

24

56

21

29

57

AssaultedPartner

AssaultedbyOther

Sexassaultaschild

WitnessedAssault

WitnessedSexAssault

WitnessedDeath

Witnessphysicalfamily

MeanNumberofEvents:4

47

2006; Scarpa, Haden, & Hurley, 2006; Scarpa, Hurley, Shumate, & Haden, 2005; Scarpa,

Fikretoglu, Bowser, Hurley, Pappert, Romero, Van Voorhees, 2002).

At the same time, the chronically homeless often have exhausted their support

networks over time through their repeated bouts of instability. This study measured the

clients’ social support network in two ways. The baseline questionnaire asked participants

to indicate how much contact they had with close relatives, friends, clergy or others on a

weekly basis. In addition, the participants completed a short form of the Social Support

Questionnaire, also known as the SSQ6 (Sarason, Sarason, Shearin, & Pierce, 1987). The

short form contains only 6 questions, as opposed to the 27 questions included in the

original, however, the researchers found high correlations between the scales. As seen in

Table 10, while participants indicated that they felt satisfied with those that they could rely

on, only 55% indicted that they had a friend they could rely on.

Table 10: Participant’s Support System Variable N % Do you have a friend you could rely on if in trouble?

Yes 23 54.8 No 19 45.2 Wish for better relationship with family

Yes 22 53.7 No 19 46.3 Social Support Questionnaire

Average # of supports 12

Over half of the clients indicated that they wished they had a better relationship

with their family members. When clients were asked to report what stood in their way of

having a better relationship with family members, they reported the following: “just

homelessness and what comes with that,” “could be better, but I take the blame it is my

48

fault,” “theft has created a rift between mom and me,” “separated for so long, it’s hard to

build a relationship back up and for them to trust that I am clean,” “guilt over what my life

was like in the past,” “my family has shunned me,” “I want to get my life together more,”

and several participants noted that there is “a lot of hurt from the past” when it comes to

their relationship with family members. Overall, however, participants indicated that they

did have other people in their lives to rely on with an average of 12 people noted.

Areas in Need of Assistance

The clients were also asked to identify their current needs now that they were

housed in the MeckFUSE program. As expected, they did not identify rent, electricity,

heat, or phone as an issue given those were provided to the client as part of the program.

However, as noted in Table 11, transportation (64%), money/finances (64%), and

food/groceries (64%) were identified as the most pressing needs. These needs were

followed by assistance with employment (60%), clothing (55%), driver’s license

paperwork (52%), and education (50%).

TABLE 11: Participant Self-Reported of Needs at Intake into the MeckFUSE program Variable N % NEEDS HELP WITH Transportation 27 64.3 Money 27 64.3 Food 27 64.3 Employment 25 59.5 Clothing 23 54.8 Driver’s License 22 52.4 Education 21 50.0 Gov’t Benefits 14 33.3 Housing 12 28.6 Electric Bill 11 26.2 Legal 5 11.9 Childcare 1 2.4

49

SECTION V: OUTCOME EVALUATION

Outcome evaluations are designed to provide stakeholders with important

information regarding how well the program achieved its stated goals. With a program like

MeckFUSE, a number of outcomes are important. For the current study, three sets of

outcomes are examined. The first set of outcomes examines whether the MeckFUSE

program improved client stability and/or reduced public service utilization (e.g., pre/post

shelter, pre/post hospital and ambulatory services). The second set of outcomes examines

differences in outcomes among those retained in the housing compared to those terminated.

The third set of outcomes examines MeckFUSE participant arrest rates compared to a

similar group of individuals who do not receive MeckFUSE housing or services.8

The following research questions are examined:

• Does participation in the MeckFUSE program improve stability among those

involved in the study at year 3 (e.g., improved functioning in areas such as

education, employment, relationships with family, use of alcohol or drugs, mental

health status, physical health, and trauma exposure)?

• Do the rates of shelter and emergency care utilization prior to MeckFUSE

involvement differ from the rates post involvement?

• What factors influence whether a participant will remain housed at the year 3

interview?

• Does retention in the MeckFUSE program reduce arrests, shelter usage, and

emergency care utilization?

8Wewereunabletoobtainconsentfromcomparisongroupmemberstocollecthospitalandambulatorycostdata.

50

• Did involvement in the MeckFUSE program impact arrest rates and shelter usage

when compared to those served through traditional avenues?

METHODOLOGY

Data Collection

Outcome #1: MeckFUSE Client Stability & Pre/Post System Utilization Patterns.

The first set of analyses examines whether participation in MeckFUSE services improves

client stability. Data were gleaned from the participant interviews at Time 1 (within one

month of entry into MeckFUSE) and Time 3 (two years after initial entry into MeckFUSE).

The interview guide asked the individual to report on a number of outcomes such as

educational status, employment status, ratings of physical health, etc. The interview guide

also asked FUSE participants in the study to provide further details about particular issues

(e.g., employment struggles). Where relevant, the results of these open-ended questions are

provided in the form of italicized quotes.

The second set of analyses examines whether participation in MeckFUSE housing

and services reduced system utilization patterns. System utilization data were collected

from three sources. First, utilization data from the local shelters post-entry into the

MeckFUSE program were collected in early 2017.9 Second, billing information from the

local hospitals were collected for clients three years prior to their involvement in

MeckFUSE and again approximately three years’ post-involvement in MeckFUSE. 10

9Data was collected by the Men’s Shelter of Charlotte, Room in the Inn and the Salvation Army of Greater Charlotte Center of Hope. 10 Novant and Carolinas Medical Center provided data for three years prior. Carolinas Medical Center provided data for the three years post involvement in MeckFUSE.

51

Third, ambulance transports and billing information were collected by the Mecklenburg

Emergency Management System Agency (MEDIC) for the years 2012 through 2016.11

Outcome #2: MeckFUSE: Retained vs. Terminated Client Outcomes. The second

set of analyses utilizes data from the face-to-face interviews12 with clients and system

utilization. The system utilization data noted in analysis 1 is the same, however, the results

are displayed by program status (terminated vs retained) as of November 2016.13

Outcome #3: MeckFUSE vs. Comparison Group. A quasi-experimental matched

comparison group design was utilized to estimate the impact of MeckFUSE involvement

on two important outcomes: arrest and shelter usage. The quasi-experimental design is a

common approach with program evaluations since random assignment is difficult to obtain

in court-related programs.14 A weakness of this design is the potential for selecting a

comparison group that is dissimilar to the program group and therefore does not permit a

valid interpretation. A common way to overcome this problem is to match the comparison

group with the treatment group on key characteristics. Matching clients should minimize

potential for unknown differences associated with outcome. The 42 MeckFUSE

participants were matched to comparison group members based on gender, age, race, and

prior arrest record. The matching procedure produced a comparison group of 42

individuals.

11 Data were collected from January 2012 to September 2016. We were unable to obtain ambulance service data prior to 2012 because those bills were in a legacy system that could no longer be accessed. 12Data collection described in detail in the process evaluation. 13 The date coincides with the last of the Time 3 interviews 14 There are several problems with a quasi-experimental design, which should be noted. Without randomizing to the treatment and control groups it is difficult to control for every factor that could be related to the dependent variable. Studies must match participants on key characteristics that are predictive of the outcomes under study to reduce selection bias.

52

Of primary interest is whether participation in the MeckFUSE (i.e., the ‘treatment

group’) influences the probability that an individual will continue to utilize shelters and be

arrested in the community, two important indicators of “frequent users” targeted by the

program. Shelter usage data for consenting MeckFUSE participants were provided by the

local shelters. Comparison group members were not directly contacted and were therefore

unable to provide consent for shelter usage data. Without consents, the shelters provided

an average number of days spent in shelters (rather than identifiable data) by the individuals

in the comparison group. These data allow for a general assessment of the average number

of days spent in the shelter between the two groups but do not allow for a comprehensive

assessment of shelter usage by comparison group members. Finally, UNCC researchers

collected recidivism data via the Court Information Public Record System (CIPRS). CIPRS

allowed researchers to collect data from across the state from 1965 to 2017. Available data

included infractions, misdemeanors, and felonies, ranging in severity from traffic

violations to serious crimes.

RESULTS

Outcome #1: MeckFUSE Client Stability & System Utilization

Client Stability. An area of interest among stakeholders of the MeckFUSE program

is the degree to which the services provided were able to improve clients’ functioning and

stability. The following analysis examines the improvements among clients interviewed at

Time 1 and Time 3.15 Time 1 interviews occurred during the first month that MeckFUSE

participants were accepted and placed in housing. Time 3 interviews occurred two years

post placement in housing.

15The results compiled for those interviewed at time 1, time 2, and time 3 are provided in Appendix A.

53

Urban Ministry Center is the contracting agency that oversees MeckFUSE

program. The project manager and case managers provide intensive case management

services to clients. Those services include: referrals to treatment agencies (e.g. substance

abuse, mental health), mediating housing issues, making educational and employment

referrals, providing transportation to appointments (e.g., doctor’s visits, court hearings),

and offering supportive services such as peer counseling. The staff have added additional

services to clients offered at the Urban Ministry Center’s Moore Place location, including

Wellness Recovery Action Plan (WRAP) groups. An analysis of client contacts maintained

by Urban Ministry Center staff indicates that participants receive an average of 4 contacts

with case managers per month.

Participants were asked to describe their life now that they had been part of the

MeckFUSE program. Overall, participants indicated that their quality of life had improved

since entering MeckFUSE. Specifically, participants noted that life was: “A whole lot

better. I’m not living on the streets with my belongings in tote bags;” “Great, a lot better

than last year. Health has improved due to seeing a doctor regularly;” “Great! I just got

my GED in May, excited to start college in the fall;” and “My life is normal, peaceful,

quiet, and wonderful.” Of particular interest are the improvements made in the following

life areas: education, employment, relationships with family, use of alcohol or drugs,

physical health and health symptoms impacting participants’ quality of life.

With regards to education and employment, the findings are mixed. In terms of

education, there are some positive findings to note. For example, nearly a fifth of the

participants had improved their education level by Time 3 with most indicating progress

towards obtaining a GED certificate. With regards to employment, Figure 10 illustrates

54

fewer participants were employed at time 3 (14%) as compared to time 1 (24%). In an

effort to understand this trend, participants were asked to report whether they had difficulty

finding a job and why they might have found it difficult. Overall, participants noted their

criminal history and health issues were major barriers to employment, stating they were

having difficulty finding work due to: “my background with felonies;” “a bad criminal

record;” “disability, HIV positive stigma, criminal background;” “disabled from two

heart attacks;” “…need a hip replacement;” “injuries and disability;” “medical problems

following a car accident;” and “the work I have had has only been temporary, a few

assignments of filling in for others.”

Further examination indicates that four participants who were initially employed

were no longer employed due to physical or mental health issues, while several participants

Figure10.Percentofparticipantsemployed:

Time1vs.Time3

23.8

14.3

0

5

10

15

20

25

30

35

Time1 Time3

55

who were initially employed were no longer in the program. It is important to note that by

interview 3, four participants who were initially unemployed had indeed found

employment. Perhaps more important is the participants’ financial status. More participants

were receiving SSI and SSDI benefits by Time 3, which indicates a greater level of

financial stability when compared to panhandling or working odd jobs for income.

Therefore, participants’ financial stability has likely improved, despite the lack of formal

employment. However, as noted in Table 12, over a third of the clients were making some

contribution towards rent, although 94% indicated that they would not be able to afford

rent without the assistance of the MeckFUSE program.

TABLE 12: Participant Financial Information Time 3 Variable N % INCOME SOURCE Employed 2 7.1 Odd Jobs 8 28.5 Benefits 11 39.2 Family 2 7.1 No means 2 7.1 Other 3 10.7 PAYING SOME RENT Yes 10 35.7 No 18 64.3 AFFORD RENT Yes 2 7.1 No 26 92.9

Improved relationships with family members are another area of interest. With

regard to relationship with family, participants were also asked about their relationships

with their children. As seen in Table 13, 57% percent of those participating in MeckFUSE

indicated that the program had helped improve relationships with their children.

Participants were asked how it has improved the relationship, and they reported: “If it

56

weren’t for FUSE, I probably wouldn’t be talking to them. Having stable housing has

helped;” “It [MeckFUSE] has brought us closer together;” “[my situation is] more stable,

daughter can visit me;” and “When I was out on the streets, I’d talk to her, but now I talk

to her every day.”

Table 13. Participants’ Relationships Variable N % Has your relationship with children improved?

Yes 8 57.1 No 6 42.9 Could you call family if in need?

Yes 21 75.0 No 7 25.0

Participants were also asked how family members feel about the person’s

involvement in MeckFUSE. While some participants indicated that they did not have

contact with family, the majority was positive in their remarks. For example, many reported

that their families liked that the participants were involved in MeckFUSE: “They don’t

have to worry about me;” “They’re happy that I have a stable place to live;” “They’re

relieved that I am off the streets;” “They are proud and happy for me;” and “They love

the fact that I am not homeless and that I work and am independent.”

Participants were asked to self-report use of drugs and alcohol. As shown in Figure

11, 24% of the participants indicated at Time 1 indicated that they were currently using

drugs or alcohol. At time 3, the percentage had increased slightly to 29%. There are a

couple of potential reasons for this increase. First, there may have been an issue with self-

reporting. It is possible that participants were more honest at time 3, knowing that their

housing status/benefits would not be impacted. Second, substance abuse treatment was

voluntary, so MeckFUSE participants may not have utilized the services available to them,

57

while others may have relapsed into older patterns of substance use without seeking

treatment.

Physical health status of participants was also examined. In particular, participants

were asked to rate their health compared to a year ago. As shown in Figure 12, about 43%

indicated that their health was somewhat or much better than the previous year, while only

7% indicated that their health declined. This could in part be attributed to the work of

MeckFUSE caseworkers who work diligently to set up doctor’s appointments and

Medicaid benefits for participants. As illustrated in Figure 13, the vast majority of

participants indicate that they regularly see a doctor for their health care needs. This is an

important accomplishment that would be expected to result in reduced utilization of

emergency care services at the local hospitals.

Figure11.Selfreporteduseofdrugsoralcohol

Time1vs.Time3

24.4

28.6

10

15

20

25

30

35

Time1 Time3

58

Figure12.Participants’healthratingstime3

comparedto1yearago

3.6

3.6

50

21.4

21.4

0 10 20 30 40 50 60

Muchworse

Somewhatworse

Aboutthesame

Somewhatbetter

Muchbetter

Figure13.Participantswhohaveadoctorasregularsourceofmedicalcare

89%

11%

Percent

Yes No

59

System Utilization. Figures 14 through 17 illustrate the participants’ system

utilization prior to and since entry into the MeckFUSE program. As shown in Figure 14,

participants spent an average of 27816 days in homeless shelters in the five years prior to

beginning the FUSE program. Since entry into the program, however, participants spent an

average of just 37 days17 in shelters (n = 8),18 meaning participation in the MeckFUSE

program was related to spending fewer days in homeless shelters in the three years since

MeckFUSE began.

16Medianis43days17Medianis22days18 This finding was statistically significant at the p < .05 level.

Figure14.Participants’averagenumberofdaysspentinshelter

Pre&PostMeckFUSE278

37

Pre Post0

50

100

150

200

250

300

Statisticallysignificant<.05

60

The average cost of shelter bed per day was estimated at $22.50. The costs incurred

by participants pre MeckFUSE was $160,964 19 . The costs to shelters incurred by

participants post MeckFUSE was $1,552.5020. These figures represent a cost savings of

$159,411.50, which is the equivalent of nearly $4,000 per participant in cost savings.

From January 2012 into entry into the MeckFUSE program, participants’ average

ambulance service charges were $4,758.21 Since entry into the program, participants’

average charges dropped to $3,639, as seen in Figure 16. The difference costs to MEDIC

19This figure was calculated as the average shelter cost per day ($22.50) multiplied by the number of days spent in shelters by each participant over a five year period prior to MekFUSE implementation 20 This figure was calculated as the average shelter cost per day ($22.50) multiplied by the number of days spent in shelters by each participant over a three year period post entry into MeckFUSE housing. 21 As noted previously, data prior to 2012 was unable to be obtained because those bills were in a legacy system that was unable to be accessed.

Figure15.Averagecoststolocalsheltersprevs.postMeckFUSE

$160,064

$1,552$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

Pre Post

Chargesindollars

61

for ambulatory services between the pre and post involvement in MeckFUSE is statistically

significant. The average median ambulance charges to participant’s prior to MeckFUSE

were $2,299, and thisnumberfelltojust$1,677post-MeckFUSE.

Figure 17 displays the participants’ average total hospital charges prior to and since

entry into the MeckFUSE program. For the three years prior to beginning the program,

participants’ average total hospital charges were $21,089. Since entry into the program

(2013-2016), average hospital charges dropped to $12,007, a 43 percent reduction.22 The

median hospital charges prior to MeckFUSE were $7,108, which declined to just $2,068

post-involvement in MeckFUSE.

22 This finding was statistically significant at the p < .05 level.

Figure16.Meanandmedianambulancecosts

prevs.postMeckFUSE

47583639

2299 1677

0500100015002000250030003500400045005000

Pre Post

Mean Median

62

Outcome #2: MeckFUSE: Retained vs Terminated Client Outcomes

As of November 2016, 13 of the 42 clients interviewed for this study were

discharged from the MeckFUSE program. One client died during his tenure in the program,

and one individual had a medical event that led to his movement to a higher level of care.

One individual dropped out of the program and one client was removed due to arrest. One

individual was sent to long term substance abuse treatment, and two clients were removed

due to lengthy jail or prison sentences. The remaining six clients, including two women

and four men, were discharged as unsuccessful.

It is important to examine what factors predict retention in MeckFUSE at year three

of the program. The multivariate model examines the factors that predict retention to

determine what factors increase the likelihood of successful completion of the MeckFUSE

program. A multivariate analysis was conducted to estimate the probability of retention in

Figure17.Meanandmedianhospitalcharges

prevs.postMeckFUSE

21089

12007

71082068

0

5000

10000

15000

20000

25000

Pre PostMean Median

63

MeckFUSE. Variables included in the model were age, gender (1=male), number of arrests

prior to MeckFUSE, number of days spent in a shelter in the five years prior to MeckFUSE,

average hospital bill, prior substance abuse (1=yes), and a mental illness diagnosis (1=yes).

As seen in Table 14, only one of the included variables was found to be significantly related

to retention in the MeckFUSE program. Those with a history of mental illness were less

likely to be retained in MeckFUSE study at the time 3 interview. The most common two

diagnoses reported among those terminated from the program was bipolar disorder and

schizophrenia. While difficult to assess why those with mental health problems were more

likely to be terminated, staff should be mindful of this pattern.

Table 14: Logistic Regression Equation Predicting Retention in MeckFUSE Variable B SE Significance Age .011 .061 .856 Gender -2.592 1.186 .251 Avg Pre Hospital .000 .000 .280 # Prior Arrests -.023 .020 .251 # Prior Days in Shelter .001 .002 .492 Mental Illness Diagnosis* -3.329 1.517 .022 (Constant) 1.369 2.314 .554

*p<.05

It is important to examine whether outcomes differ among those retained in

MeckFUSE compared to those who were terminated from the program. An important

measure of effectiveness is the differences in arrest and shelter usage among those retained.

Retained participants are an important group to explore given these individuals received

the full dosage of services offered by the intervention.As illustrated in Figure 18, 52% of

MeckFUSE participants who completed the program were arrested in the three years since

entry into the program, while 77% of those who were terminated from the program were

arrested.

64

Similarly, as seen in Figure 19, only 41% of participants who were retained in the

program were arrested multiple times since entry to the program, while almost 70% of

those who were terminated from the program were arrested more than once. As Figure 20

shows, participants who were retained in the program averaged only 2.1 arrests since entry

into MeckFUSE. In contrast, participants who were terminated from the program averaged

9.5 arrests since entry into the program, which is statistically significant.

Figure18.PercentofparticipantsarrestedpostMeckFUSE:

Retainedvs.Terminated

51.9

76.9

0

10

20

30

40

50

60

70

80

90

Retained Terminated

65

Figure19.Percentofparticipantsarrestedmultipletimes

postFUSE:Retainedvs.Terminated

40.7

69.2

0

10

20

30

40

50

60

70

80

Retained Terminated

Figure20.Averagenumberofarrests postMeckFUSE

Retainedvs.Terminated

2.1

9.5

0

2

4

6

8

10

12

14

Retained Terminated*p<.05

66

Finally, of the 42 MeckFUSE participants, only eight spent time in shelters since

the program began. These shelter days can partly be explained by problems with a few of

the landlords, which led to few tenants being forced to stay in shelters for short times while

new apartment leases were secured. Only 10% (n = 3) of those who were retained in the

program utilized homeless shelters since entry into the program, while 38% (n = 5) of those

terminated from the program utilized shelters since MeckFUSE began. As Figure 21

shows, those who were retained in the program spent an average of only 2223 days in

shelters, while those who were terminated from the program spent 4624 days in shelters,

which was statistically significant. Those who were retained in MeckFUSE spent

significantly fewer days in homeless shelters.

23Medianis21days24Medianis24days

Figure21.Participants’averagenumberofdaysspentin

shelterpostMeckFUSE

22.3

46

0

10

20

30

40

50

60

Retained Terminated

67

Outcome #3: MeckFUSE vs. Comparison Group

The comparison group was selected utilizing the same list of individuals from

which the MeckFUSE clients were selected. The comparison group members were

matched to the MeckFUSE participants based on age, race, gender, and number of prior

arrests. As seen in Table 15, there were no significant differences between the MeckFUSE

Table 15: Key Demographics & arrest information: MeckFUSE vs. Comparison Group MeckFUSE Comparison Variable N % N % Gender Male 36 85.7 36 85.7 Female 6 14.3 6 14.3 Race White 6 14.3 6 14.3 Black 33 78.6 36 85.7 American Indian

1 2.4 0 0.0

Other 2 4.8 0 0.0 Mean Age 50.8 51.0 Mean # of Prior Arrests

39.6 39.1 Arrested Post FUSE**

Yes 24 60.0 31 73.8 No 16 40.0 11 26.2 Mean # of Arrests Post FUSE

4.5 9.3 Arrested Multiple Times Post**

Yes 20 50.0 27 64.3 No 20 50.0 15 35.7 Avg. Time to Arrest Post (days)

467.3 157.8

68

participants and the comparison group on the key demographics by which they were

matched.

As seen in Table 15, approximately 74% of the comparison group was arrested in

the three years since the MeckFUSE program began, compared to only 60% in the

MeckFUSE program. Importantly, the average amount of time from the beginning of the

program to time of first arrest comparison group was 158 days, or approximately five

months. For MeckFUSE participants, the average time from entry to first arrest was 467

days, or approximately 15 months, meaning that MeckFUSE participants were arrest-free

for three times as long as the comparison group. 25 The charge type illustrates some

important differences between MeckFUSE participants and comparison group members.

For example, more comparison group members were arrested on a drug charge, but more

MeckFUSE participants were arrested for assault.

25 This finding is statistically significant at the p < .05 level.

69

Figure21.PercentarrestedpostFUSEMeckFUSE vs.Comparison

60

73.8

0

10

20

30

40

50

60

70

80

90

FUSE Comparison

70

Fifty percent of the MeckFUSE participants were arrested multiple times since entry into

the program, compared to 64% of the control group, as shown in Figure 23. As shown in

Figure 24, the average number of arrests since MeckFUSE began was 4.5 for all

MeckFUSE participants, compared to 9.3 arrests for the comparison group, which is

statistically significant.

Figure22:MostSeriousChargeTypeMeckFUSE vs.Comparison

25

8.3

58.3

0

8.3

35.5

16.1

25.8

6.5

16.1

0

10

20

30

40

50

60

70

Drug Theft Assault Traffic Other

MeckFUSE Comparison

71

Figure23.PercentarrestedmultipletimespostFUSE

MeckFuse vs.Comparison

50

64.3

0

10

20

30

40

50

60

70

80

FUSE Comparison

Figure24.AveragenumberofarrestspostFUSE

MeckFUSE vs.Comparison

4.5

9.3

0

2

4

6

8

10

12

FUSE ComparisonStatisticallysignificantp<.05

72

A multivariate analysis was conducted to estimate the probability of arrest while

taking into consideration MeckFUSE program involvement (1=MeckFUSE participant)

and a number of control variables. Control variables included in the model were age,

gender (1=male), race (1=Caucasian), number of arrests prior to MeckFUSE, and number

of days the individual spent in a shelter prior to MeckFUSE. As seen in Table 16,

participation in MeckFUSE, age, and number of arrests prior to MeckFUSE were

significant predictors of arrest. Those who received MeckFUSE services, were older, and

had fewer arrests prior to MeckFUSE were less likely to be arrested during the follow-up

period.

Table 16: Logistic Regression Equation Predicting Arrest Variable B SE Significance Comparison Group* -1.538 .662 .020 Younger* -.088 .041 .032 Gender 1.177 .907 .195 Race 1.125 .873 .197 # Prior Arrests* .064 .023 .006 # Shelter Days .002 .001 .070 (Constant) 2.565 1.839 .163

*p<.05

It is also important to examine the arrest rate for those retained in MeckFUSE

compared to both those who were terminated from the program and the comparison group.

As Figure 25 illustrates, 52% of those retained in the program, were arrested since entry

into MeckFUSE, while 77% of those terminated were arrested.26 For those who were

retained in MeckFUSE, there was a 30% reduction in arrest when compared to the control

group.

26 Arrest alone was not grounds for termination from MeckFUSE.

73

As Figure 26 shows, only 41% of those who were retained in the program were arrested

multiple times since MeckFUSE began, while 69% of those who were terminated from

MeckFUSE were arrested multiple times. Finally, as Figure 27 illustrates, the arrest rate

for those retained in MeckFUSE was only 2.1, as compared to 9.5 in for those terminated

from MeckFUSE, a statistically significant difference.

Figure25.PercentarrestedpostFUSE:

Retained,Terminatedvs.Comparison

51.9

76.9 73.8

0

10

20

30

40

50

60

70

80

90

Retained Terminated Comparison

74

Figure26.PercentarrestedmultipletimespostFUSE:

Retained,Terminatedvs.Comparison

40.7

69.264.3

0

10

20

30

40

50

60

70

80

Retained Terminated Comparison

Figure27.AveragenumberofarrestspostFUSE:Retained,Terminatedvs.Comparison

2.1

9.5 9.3

0

2

4

6

8

10

12

Retained Terminated Comparison*p<.05

75

The last analysis examines the average number of days spent in the local shelters

by the MeckFUSE group in contrast to the comparison group members. Only aggregate

data were available for comparison group members, which limits the ability to examine

shelter stays in detail. As shown in Figure 28, on average, the MeckFUSE group spent

significantly fewer days in the shelter post engagement than members of the comparison

group.

Figure28.AveragenumberofshelterdayspostFUSE

MeckFUSE vs.Comparison

37.5

72.5

0

10

20

30

40

50

60

70

80

90

100

FUSE ComparisonStatisticallysignificantp<.05

76

VI: CONCLUSIONS & RECOMMENDATIONS

This evaluation examines whether the MeckFUSE pilot program impacted a wide

array of outcomes for program participants, including quality of life, public systems

utilization, and arrest rates. Overall the results indicated that the MeckFUSE program is

having a significant and positive impact in all areas. In particular, participants reported an

increase in their quality of life since entry into MeckFUSE program. Some participants

completed their GED, while many improved relationships with their children and families.

Additionally, most participants’ health improved or stabilized over the course of

participation, with very few participants reporting declining health. Importantly,

MeckFUSE participants reported seeing a doctor for regular healthcare.

In terms of system utilization, MeckFUSE participants incurred fewer arrests,

experienced reduced hospital usage and ambulance usage, and spent fewer days in the local

shelters. Cost savings were realized in the areas of shelter stays, ambulance charges, and

hospital utilization. Importantly, those who were retained in MeckFUSE experienced the

greatest reduction in these measures. About half of the retained participants were arrested

post-MeckFUSE, compared to approximately two-thirds of those terminated from the

program. Similarly, only 40% of those retained in MeckFUSE were arrested multiple times

since entry into the program, compared to almost 70% of those who were terminated. On

average, the overall arrest rate for those retained in MeckFUSE was only 2.1, compared to

9.5 for those who were terminated, a statistically significant reduction in arrest post-

MeckFUSE. Finally, not surprisingly, those who were retained in MeckFUSE spent

significantly fewer days in homeless shelters than those who were terminated from the

program. Retention in MeckFUSE was associated with a 30% reduction in number of

77

arrests compared to the control group. Overall, MeckFUSE has succeeded in improving

participants’ quality of life and reducing system utilization among participants, particularly

those who were retained in MeckFUSE and received the full dosage of treatment.

The MeckFUSE pilot project is, as it names implies, a work in progress. The

screening and admission process appears to be well established and the program is

appropriately targeting those who are frequent users of jails and shelters. It appears that

Urban Ministry Center staff were able to successfully leverage a number of community

resources to provide goods and services to the clients (e.g., assistance with furniture,

moving costs, and security deposits) and has maintained a stable core of staff throughout

the duration of the evaluation.

The clients appreciate the services that they are being given. For example, when

clients were asked what they like the best about the MeckFUSE program within the first

months of housing, they indicated “it is opening doors and providing opportunities,”

“peace,” “everything, how the caseworker treats me and all of the help that I receive,”

“being able to have a steady place to be, helps with wanting to improve my daily life by

getting an education,” “gave me a place to live so I can look for a job,” “being off the

streets and out of the cold,” and “it is a blessing since I have been homeless for 16 years.”

In terms of recommendations, the MeckFUSE program has evolved over time and

continues to develop relationships with community partners to further enhance the

wraparound service approach. However, the program staff should continue to be mindful

of those who have additional needs beyond homelessness; particularly among those with

substance abuse and mental health needs. Engaging these clients in treatment services is

important in order for MeckFUSE to reach its full potential. While the program is working

78

to empower the clients to choose whether and to what degree they want to participate in

services, the caseworkers should continue to rely on motivational interviewing techniques

to enhance the clients’ willingness to engage in services. Research suggests that these

techniques are very effective in increasing clients’ motivation to participate in treatment.

Cognitive behavioral interventions for substance abuse should also be explored, as they are

not currently offered to MeckFUSE participants. These approaches are very effective in

targeting substance use and related offending behavior and could enhance the effectiveness

of the program given a third of the arrests among participants involved alcohol and drugs.

Not surprisingly, those who were retained in MeckFUSE program had the best

outcomes. Thus, emphasis should be placed on better understanding the factors that impact

retention or termination from the program, with the ultimate goal of retaining more

individuals in MeckFUSE. Much can be learned from examining the participants who were

terminated. Although the analyses identified that mental illness was the only factor

predicting retention, the analysis of arrest suggests that other factors could be important

too. Given the study only focused on the first 42 individuals housed, it would benefit the

program staff to identify factors predicting retention with the current group of individuals

served by the program.

There are several limitations to this study that should be noted. While the

comparison group was matched to MeckFUSE participants on several key factors (e.g. age,

gender, race, criminal history), there may be other factors that impact recidivism outcomes

that we were unable to collect on comparison group members. In particular, their

employment histories, health concerns, and motivation to change were unavailable.

Moreover, the study is unable to assess whether the comparison group members received

79

any other type of treatment or housing services during this timeframe. Additionally, we

were unable to collect hospital or shelter data for the comparison group to examine

differences in pre/post hospital and shelter utilization. Finally, the small sample size limited

the ability of the analyses to detect small, but perhaps significant differences in outcomes.

These limitations notwithstanding, the study adds to the current literature by providing a

comprehensive assessment of a relatively new initiative. The MeckFUSE program has

proven to be successful in reaching its initial goals.

80

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APPENDIX A

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TABLE 1: Participant Demographics by Interview Time Period T1 T2 T3 Variable N % N % N % AGE 18-24 0 0.0 0 0.0 0 0.0 25-34 4 9.5 2 6.3 2 7.1 35-44 9 21.4 7 21.9 5 17.9 45-54 20 47.6 17 53.1 16 57.1 55-64 9 21.4 6 18.8 5 17.9 65+ 0 0.0 0 0.0 0 0.0 GENDER Male 36 85.7 28 87.5 25 89.3 Female 6 14.3 4 12.5 3 10.7 RACE Caucasian 6 14.3 3 9.4 2 7.1 African-American 33 78.6 26 81.3 23 82.1 American Indian 1 2.4 1 3.1 1 3.6 Other 2 4.8 2 6.3 2 7.1 ETHNICITY Non-Hispanic 39 92.9 30 93.8 27 96.4 Hispanic 3 7.1 2 6.3 1 3.6 EDUCATION <High School/GED

22 52.4 16 50.0 14 50.0

High School/GED

14 33.3 11 34.4 10 35.7

>High School/GED

6 14.3 5 15.6 4 14.3

MILITARY SERVICE*

Yes 3 7.1 3 10.0 2 7.7 No 37 88.1 27 90.0 24 92.3

*Two missing responses

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TABLE 2: Participant Demographics & Religiosity T1 T2 T3 Variable N % N % N % MARITAL STATUS Married 0 0.0 0 0.0 0 0.0 Single 30 71.4 23 71.9 20 71.4 Separated 4 9.5 4 12.5 4 14.3 Divorced 8 19.0 5 15.6 4 14.3 EMPLOYED Yes 10 23.8 8 25.0 8 28.6 No 32 76.2 24 75.0 20 71.4 RELIGIOUS** Yes 32 76.2 25 78.1 21 75.0 No 9 21.4 7 21.9 7 25.0 ATTEND SERVICES Yes 24 57.1 20 62.5 16 57.1 No 8 19.0 5 15.6 5 17.9 N/A 10 23.8 7 21.9 7 25.0 PRAYS REGULARLY

Yes 29 69.0 23 71.9 19 67.9 No 3 7.1 2 6.3 2 7.1 N/A 10 23.8 7 21.9 7 25.0

**One missing response

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TABLE 3: Participant Criminal Justice System History T1 T2 T3 Variable N % N % N % JUVENILE ARREST Yes 18 42.9 14 43.8 12 42.9 No 24 57.1 18 56.3 16 57.1 ADULT CONVICTION Yes 41 97.6 31 96.9 27 96.4 No 1 2.4 1 3.1 1 3.6 ARREST IN <6 MONTHS

Yes 15 35.7 10 31.3 8 28.6 No 27 64.3 22 68.8 20 71.4 CHARGES CURRENTLY PENDING

Yes 7 16.7 4 12.5 4 14.3 No 35 83.3 28 87.5 24 85.7 HISTORY OF VIOLENCE

Yes 13 31.0 11 34.4 10 35.7 No 29 69.0 21 65.6 18 64.3

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TABLE 4: Participant History of Homelessness T1 T2 T3 Variable N % N % N % TOTAL TIME IN SHELTER

3-5 Months 2 4.8 2 6.3 2 7.1 6-11 Months 1 2.4 0 0.0 0 0.0 >12 Months 39 92.9 30 93.8 26 92.9 EVER LEASED HOME

Yes 18 42.9 14 43.8 12 42.9 No 24 57.1 18 56.3 16 57.1 EVER OWNED HOME

Yes 5 11.9 4 12.5 3 10.7 No 37 88.1 28 87.5 25 89.3

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TABLE 5: Participant Current FUSE Housing T1 T2 T3 Variable N % N % N % RATING OF APT Very Poor 0 0.0 0 0.0 0 0.0 Poor 0 0.0 0 0.0 0 0.0 Fair 0 0.0 0 0.0 0 0.0 Good 10 23.8 7 21.9 6 21.4 Very Good 11 26.2 6 18.8 6 21.4 Excellent 21 50.0 19 59.4 16 57.1 PAYING SOME RENT

Yes 13 31.0 9 28.1 7 25.0 No 29 69.0 23 71.9 21 75.0 SOURCE OF MONEY

SSDI 6 14.3 4 12.5 3 10.7 Earnings 5 11.9 5 15.6 5 17.9 SSI 2 4.8 1 3.1 0 0.0 N/A 29 69.0 22 68.8 20 71.4

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TABLE 6: Participant Physical Health Status T1 T2 T3 Variable N % N % N % HEALTH RATING Very Poor 1 2.4 1 3.1 1 3.6 Poor 5 11.9 2 6.3 1 3.6 Fair 12 28.6 10 31.3 8 28.6 Good 9 21.4 7 21.9 6 21.4 Very Good 5 11.9 5 15.6 5 17.9 Excellent 10 23.8 7 21.9 7 25.0 DAILY PAIN None 18 42.9 15 46.9 13 46.4 Very Mild 6 14.3 5 15.6 4 14.3 Mild 1 2.4 1 3.1 1 3.6 Moderate 5 11.9 2 6.3 2 7.1 Severe 7 16.7 5 15.6 5 17.9 Very Severe 5 11.9 4 12.5 3 10.7 DOES PAIN INTERFERE

Not at All 11 26.2 9 28.1 8 28.6 A Little Bit 2 4.8 2 6.3 2 7.1 Moderately 3 7.1 1 3.1 1 3.6 Quite a Bit 2 4.8 1 3.1 1 3.6 Extremely 6 14.3 4 12.5 3 10.7 N/A 18 42.9 15 46.9 13 46.4

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TABLE 7: Participant Health System Usage T1 T2 T3 Variable N % N % N % HOSPITAL IN <6 MONTHS

Yes 12 28.6 8 25.0 7 25.0 No 30 71.4 24 75.0 21 75.0 AMBULANCE IN <6 MONTHS

Yes 7 16.7 6 18.8 5 17.9 No 35 83.3 26 81.3 23 82.1 RECEIVED GOOD CARE**

Yes 13 31.0 9 28.1 8 28.6 No 0 0.0 0 0.0 0 0.0 N/A 28 66.7 22 68.8 19 67.9 RECEIVED BILL Yes 11 26.2 7 21.9 6 21.4 No 2 4.8 2 6.3 2 7.1 Don’t Know 1 2.4 1 3.1 1 3.6 N/A 28 66.7 22 68.8 19 67.9 PAID BILL Yes 1 2.4 0 0.0 0 0.0 No 10 23.8 7 21.9 6 21.4 N/A 31 73.8 25 78.1 22 78.6

**One missing response

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TABLE 8: Participant Mental Health Status T1 T2 T3 Variable N % N % N % MENTAL HEALTH HISTORY

Yes 18 42.9 12 37.5 9 32.1 No 24 57.1 20 62.5 19 67.9 PAST SUBSTANCE ABUSE

Yes-Alcohol 14 33.3 12 37.5 12 42.9 Yes-Drugs 6 14.3 5 15.6 5 17.9 Yes-Both 18 42.9 13 40.6 10 35.7 No 4 9.5 2 6.3 1 3.6 CURRENT SUBSTANCE ABUSE**

Yes-Alcohol 9 21.4 7 22.6 7 25.0 Yes-Drugs 1 2.4 1 3.2 1 3.6 Yes-Both 0 0.0 0 0.0 0 0.0 No 31 73.8 23 74.2 19 67.9 WOULD LIKE HELP

Yes 13 31.0 10 31.3 8 28.6 No 25 59.5 19 59.4 19 67.9 N/A 4 9.5 3 9.4 1 3.6

**One missing response

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TABLE 9: Participant’s Support System T1 T2 T3 Variable N % N % N % WISH FOR BETTER RELATIONSHIP WITH FAMILY**

Yes 22 53.7 19 61.3 16 59.3 No, it’s fine 19 46.3 12 38.7 11 40.7

**One missing response TABLE 10: Participant Self-Reported Needs T1 T2 T3 Variable N % N % N % NEEDS HELP WITH

Transportation 27 64.3 19 59.4 17 60.7 Money 27 64.3 21 65.6 19 67.9 Food 27 64.3 20 62.5 19 67.9 Employment 25 59.5 19 59.4 17 60.7 Clothing 23 54.8 17 53.1 15 53.6 Driver’s license 22 52.4 18 56.3 15 53.6 Education 21 50.0 15 46.9 14 50.0 Gov’t Benefits 14 33.3 11 34.4 10 35.7 Housing 12 28.6 8 25.0 8 28.6 Electric Bill 11 26.2 6 18.8 6 21.4 Legal 5 11.9 1 3.1 1 3.6 Childcare 1 2.4 1 3.1 1 3.6