Nonprofit Finance Fund spoke with Project HOME about the Philadelphia Partnership Supportive Housing Demonstration. This blog is part of an interview series with selected project partners from our Social Innovation Fund transaction structuring competition.
Tell us about the clients who will be served by this project. What challenges do they face, and what positive outcomes do you work toward?
The Philadelphia Partnership Supportive Housing Demonstration is a collaborative initiative of Project HOME, Philadelphia’s Department of Behavioral Health and Intellectual Services (DBHIDS) through Community Behavioral Health (CBH), and Corporation for Supportive Housing. It is designed to create supportive housing for 150 chronically homeless individuals recovering from substance use disorders and/or mental illness. The primary goal is to provide permanent housing and any additional support needed so they can continue to move away from homelessness and improve their lives. We will also be testing innovations in supportive housing service delivery and demonstrating that robust partnerships between stakeholders can provide cost-effective support that improves quality of life for Philadelphia’s most vulnerable residents.
The participants we seek to serve are a high-need, high-profile population. According to local reports, about 80% of homeless individuals experience both substance abuse and behavioral health challenges. This number is likely to increase, with our city mirroring the national trend of increasing opioid use in recent months. Drug overdose deaths have spiked, with nearly 700 such deaths in Philadelphia in 2015. To put these numbers into perspective, there were more than twice as many deaths from drug overdose as there were from homicide.
These individuals face many challenges, even after seeking help. There are limited housing resources available, and people ready for housing may have to wait months before being matched with a unit that is suitable for their needs. It is a further struggle for some people to maintain housing once they have moved in, as they often lose the on-site support available if they were in a more structured entry level program. In addition, the transition to housing may uproot individuals from the social networks they had during residential recovery or during their time on the streets. Finally, there is the potential for relapse and for health concerns, due to their time spent using substances.
We plan to address these challenges through additional supportive housing and service resources targeted to individuals in recovery. The demonstration will fund greater opportunities for social support and employment to strengthen participants’ networks and to offer purposeful activity. It aims to create a mobile team to respond to crises and help plan to avoid them. Additionally, all project participants will be matched with appropriate housing in what we hope to make a timely and smooth transition from homelessness into the community.
We will evaluate the effectiveness of the demonstration by assessing how long individuals stay in the community without needing to access behavioral health crisis services or ending up in jail. Furthermore, we will monitor quality of life and other positive outcomes to ensure participants are getting the support they need to live independently while in recovery. The findings we observe using these metrics will be shared with the community to inform future service design.
What are your organizational strengths/capacities that best enable you to achieve these outcomes?
Our team in Philadelphia has the right mix of expertise and motivation to deliver this demonstration. On the service side, Philadelphia has many strong supportive housing providers. Project HOME is representing them in this initiative and brings to the table an in-depth knowledge of the target population, the services currently provided, and promising enhancements to service delivery. Corporation for Supportive Housing is our transaction coordinator and has helped us navigate the field of Pay for Success. They have invaluable experience as an intermediary and investor in other supportive housing PFS initiatives. CBH, as the end payor, has been a fantastic convener and driver of this project and has led the data analysis that determined our target population and key outcomes. And these are just three of our key partners!
Perhaps the most important strength of our team is knowing how and when to draw on people with lived experience of the challenges we are addressing. We invited individuals who participated in recovery programs and live in supportive housing to take part in our leadership team meetings, where their contributions have been critical. We hosted a focus group of similar individuals to gather feedback on service and housing needs, and we plan to reconvene this group to test our more detailed service designs in the coming month. Through these interactions, we have taken on board the perspectives of individuals we are trying to better serve.
What motivated you and your partners to pursue Pay for Success as a means of delivering the outcomes you have talked about?
CBH is committed to improving behavioral health outcomes for homeless populations, and it has promoted supportive housing prior to this project. But PFS offered a table to convene stakeholders from across different initiatives to determine what new services could improve on existing outcomes and to increase the number of individuals offered housing during their recovery. The evaluation that forms a key component of Pay for Success contracts will enable them to track positive outcomes (not only the lack of negative outcomes) and will contribute greatly to both future service design and the literature on the intersection between housing and behavioral healthcare.
Equally important, the City is transitioning many of its behavioral health services to performance-based models of contracting. This follows the path of physical healthcare’s Value Based Purchasing models (where services are reimbursed based at least partly on the cost or quality of care) and reflects a national shift away from fee-for-service contracting. Pay for Success is an opportunity to test this type of performance-based contract in a way that supports service providers by thinking through processes for measuring, aggregating, and analyzing data, as well as shifting risk for achieving outcomes from providers to socially motivated investors.
And finally, we believe that this project can help to ‘grow the pie’ of housing resources. Although we could serve many program participants through turnover units in existing housing inventories, it is a key aim of the project to provide more housing for those individuals leaving residential treatment programs.
What concerns, challenges or surprises have you experienced, either specific to pursuit of PFS or more generally related to delivering on outcomes? How have these experiences influenced the development of the project or the work of your organization?
Pay for Success initiatives strive to define and codify processes that could impact service outcomes, so one challenge for us is predicting how our homelessness system will change. For example, Philadelphia is engaging in a comprehensive re-design of its coordinated entry system, which will affect how each person applies for and is matched to housing resources. This means that we will need to revisit our proposed referral and enrollment processes to ensure they dovetail with the new system once it is confirmed.
In a similar way, the changing demographics of our target population must be considered when setting performance thresholds based on data from previous years. The opioid epidemic has shifted the profile of substance users, which may affect both the service needs and outcomes achievement of participants in our demonstration in the future.
Given the changes to the City’s services and resources, and the changes to the population we are serving, we are adapting to those circumstances as best we can, but even more importantly, we are building in the flexibility in service design to accommodate these changes so that we can continue to care for these individuals to the best of our ability throughout the life of this project and beyond.