On September 20, Cook County leaders, representatives from Cook County Health and members of the Flexible Housing Pool of Chicago and Cook County gathered to recognize a milestone in the program and discuss the progress being made to connect residents with housing services.

The Flexible Housing Pool of Chicago and Cook County (FHP) was established in 2018 as a cross-sector collaboration led by the City of Chicago, Cook County Health, Corporation for Supportive Housing, the Center for Housing & Health, and other key partner organizations. FHP was established to offer permanent supportive housing to high-risk individuals and families experiencing homelessness in the City of Chicago and suburban Cook County. In doing so, FHP looks to reduce costs to crisis systems and improve health outcomes for clients of the program.

Earlier this year, the FHP marked a milestone for the program with 1,000 persons placed into permanent supportive housing.

“Creating and sustaining programs like the Flexible Housing Pool of Chicago and Cook County, which have low barriers and get individuals connected to resources quickly, is what needs to be done to ensure health, safety and equity in Cook County,” said Cook County Board President Toni Preckwinkle.

“Investing in strategies to house individuals and families while providing them access to preventive health care is a strategy that will reap enormous benefits for society as a whole,” Cook County Health CEO Israel Rocha said. “I am grateful for the work being done by the Flexible Housing Pool team and thankful to other organizations, who like Cook County Health, have seen the value in investing in programs like this.”

Funding for the program comes from a variety of private and public resources, including from the City of Chicago and Cook County Health. The pool of funds is used to support rent and services for clients of the program.

“The City of Chicago and the Department of Family and Support Services has always put our most vulnerable residents first,” Commissioner Brandie V. Knazze, Chicago Department of Family and Support Services. “Through the Flexible Housing Pool and it’s cross-sector collaboration, lives of those who were once high utilizers of the health care system, have been changed. Permanent housing is not only important in the recovery of our participants, but it has a major impact on their self-esteem and their outlook on life. DFSS is proud to be an annual funder of this much needed and innovative program.”

Clients enrolled into FHP were placed into stable housing with the Center for Housing & Health overseeing outreach, pre-tenancy and tenancy support services to all clients. Among the services provided were connections to health insurance, if eligible, while care coordinators performed home-based assessments, assisted with referrals to medical appointments, provided transportation and medical-legal services. In late 2022, a community support team began providing mental health support to FHP clients.

“This incredible feat couldn’t be possible without the support of our incredible partnerships at CHH,” Peter Toepfer, Executive Director, Center for Housing and Health. “Through a collaborative effort built off relationships, conversations, and trust, we have been able to help and support so many people and families. Change never happens alone. Only through the help of others can we continue to move forward toward ending homelessness and improving the health of our communities.”

FHP Evaluation

Dr. Keiki Hinami, Director of Applied Research for the Center for Health Equity and Innovation at Cook County Health, also presented results from an Early Impact Evaluation Report, looking at data from the beginning of the program through 2021. The report estimates that the cumulative cost offset from reductions in utilization of the region’s crisis system among adult clients was $1.4 million.

Other findings from the report were:

• Clients housed through FHP demonstrated an estimated 30 percent lower mortality rate during peak years of COVID-19 risk compared to matched controls
• Clients demonstrated a 22 percent relative risk reduction in jail registrations
• Clients showed a 19 percent relative risk reduction in emergency department visits
• Clients had a 33 percent relative risk reduction in incurring inpatient hospital stays between 2019 and 2021
• Retention rate in housing at 12 months was 94 percent

For clients diagnosed with substance use disorder, these reductions were amplified, showing a 36 percent, 26 percent and 36 percent relative risk reduction in jail registrations, emergency department visits and inpatient days, respectively.

“The reduction of utilization of the region’s crisis systems combined with reductions in mortality suggest that FHP was instrumental in reducing preventable crisis system utilization without sacrificing access to life-saving resources,” Dr. Hinami said.

Criteria

In Chicago, over 70 percent of individuals experiencing homelessness identify as Black/African American while representing 30 percent of the population. FHP’s cohort, as noted in the report, is 78 percent Black/African American clients.

Other information about participants from 2018-2021.

• 60 percent of adults and 20 percent of youth were assigned at least one ICD-10-CM code, which is defined as having a serious mental illness by the Illinois Department of Human Services Division of Mental Health
• 70 percent of adults and 21 percent of youth were coded for healthcare encounters involving substance use disorder
• 38 percent of adults and 23 percent of youth were justice system-involved, which is defined by at least a single registration in Cermak Health Services of Cook County Jail records between 2016 and 2021

Partners in the FHP applauded the findings of the report.

“The Corporation for Supportive Housing supports this collective community effort to meet the needs of our neighbors experiencing homelessness and caught in crisis systems of care. This evaluation proves that housing is healthcare, saves lives, and reduces the use of crisis systems. We applaud the city and county’s efforts and look forward to working with partners to continue investing more in the Flexible Housing Pool and other proven initiatives that help people thrive,” said Angela D. Brooks, Director, CSH Illinois Program.

“CountyCare is pleased to be able to invest in housing programs, like FHP,” said Aaron Galeener, Chief Administrative Officer, CountyCare Health Plan. “The connection between housing and health is clear and helps better the care that health systems are able to provide to our members, and ultimately helps to improve the health of our communities.”