A program that works to reduce the caseloads at Bloomington-Normal emergency rooms and the McLean County jail has seen significant growth in the last two years.
The Frequent User System Engagement [FUSE], program had 26 clients at the end of 2024. At the middle of last year, it had 56 and FUSE Program manager Nicole Kirstein said the program added 24 more clients in the second half of 2025.
FUSE has served 80 people in six years. She said FUSE has a presence at the Junction and may get additional enrollees from the Bridge, a new non-congregate shelter village, as it fills up.
“I think it's word of mouth. Our clients see the value in the work that we do and that we really care. And the program is working. They're referring their friends and the people they interact with on the streets to our program,” said Kirstein.
She said some of the bump happened when authorities shut down homeless tent encampments.
"There was a really close group of people living together, and that encampment closed up and they really didn't have that kind of family or support from one another," said Kirstein.
The majority of clients are over age 30; about half white, half Black. There are a few Latino clients. The majority are male, though Kirstein said the number of women is rising.
“I think that sometimes it's hard to trust people, and I think that we are majority a group of women, and we have peer recovery specialists so somebody who's been through what they have been through in their lives, and they can relate to that person,” she said.
Research done by Frank Beck at Illinois State University showed at mid-year in 2025, the program was meeting a goal of reducing contact with law enforcement.
“I had a client who had been arrested probably a couple times a year. I sat down and told him, 'Listen, you haven't been arrested since you joined the program.' And that was five years [ago]. And he just started crying,” said Kirstein.
She said the man told her he had been in and out of jail since he was a teenager.
Of 56 clients studied, 48 had fewer jail bookings following FUSE participation. Only eight had more. Kirstein said there are several variables among the people who were booked more.
“Maybe some of the people have violations of orders of protection, or being re-arrested for crimes that could stem from their original offense. A lot of the offenses are from trespassing, going into buildings just to stay warm, and they're not supposed to be there,” said Kirstein.
The average number of bookings dropped from 3.43 to 1.57, wrote Beck in a report to the county in December 2025.
In a year and a half after enrollment, the number of bookings for people while in FUSE averaged less than half the number in the same period before enrollment.
“This is a strong pattern in support of FUSE programming” wrote Beck.
Beck’s data also supported the program goal of targeting the most frequent users. Charges against FUSE participants tended to be weightier than for the general jail booking population. And those entering FUSE tended to be older, have more bookings and spend more time in jail than the general jail population.
A larger portion of FUSE participants have more mental health indicators than the average jail population.
“Frank's research has showed that we are getting those people in the doors,” said Kirstein.
Nearly half of FUSE clients were unhoused. Others were living in a shelter or in the process of getting housing. About a third of the population had housing.
“These are people who are living on the streets, who are dealing with real problems every day. Not having a cell phone, not having access to a calendar, is very hard, and life just happens. We're here for them whenever they're ready to come,” said Kirstein.
Services
Program participants can stay as long as they want as long as they are living in McLean County and not actively receiving similar services from another organization.
There is no specific caseload. Kirstein said everyone on the FUSE team works with each person.
“We are looking at a specific group of people, so we have a smaller caseload than some typical agencies might have. So, we have the availability to get to know our clients and build rapport with them,” she said.
That relationship can take time to build, depending on the person.
The team has two therapists and a nurse to coordinate health care and get clients established with doctors. FUSE contracts with Carle Behavioral Health for psychiatric care. Case managers do several things, including helping people get IDs, Social Security cards, birth certificates, etc.
“When you're living on the street, sometimes things go missing and so you have to start somewhere, and that's a really big barrier for people,” said Kirstein.
Benchmarks
Kirstein acknowledged FUSE needs to do more to define success. Right now, it varies from client to client.
“It could be getting housing for somebody. It could be coming in and doing therapy. They never talked to somebody before. I think that the numbers from Frank's research show that the program is successful given that there's so many less people going in [the jail] today," she said.
Marita Landreth, McLean County’s director of Behavioral Health Coordination said there are indicators the program reduces the homeless population.
“In 18 months before joining FUSE, out of the 80 total people we saw from 2019 to 2025, there were 117 contacts with the shelters. That was reduced by 30 contacts since joining FUSE,” said Landreth.
Landreth said there also are indicators FUSE clients use emergency rooms less during mental health crises.
“They might be still experiencing crisis, but instead of going straight to an emergency room, they have support where they don't have to wait in an ER or have to be hospitalized, they can have their crisis resolved here in our office or over the phone,” said Landreth.
It is harder to measure the remaining unmet need—the population of people who could benefit from FUSE who are not enrolled.
“People have to have contacts with at least two of the three different systems: the jails, the shelters or emergency rooms. And we're not always getting all of that data to reach out to people and get that,” said Landreth.
FUSE, she said, also has changed some requirements to ease entry by people recently released from prison. They had not previously been immediately eligible because they were in prison and had no contact with the jail or shelters. Landreth said it’s clear that cohort of people needs FUSE services to avoid recidivism.
“We look at the five years maybe prior to them getting the help, or the five years prior to going into prison, how many services they have received with those different systems. I think there's always room for improvement,” she said.
There may be potential to encourage enrollment among younger people who haven’t had system contacts because they received services through Project Oz or other agencies that deal with minors.
Cost calculations
Cost per client was deceptively high during the early years of the program, which included the pandemic, but has gone steadily down. Full year 2025 numbers are not available until the end of February, but in 2024, FUSE spent under $11,000 per person enrolled.
Landreth said the cost per person appears to be stabilizing, though she cautioned the averages ignore cost variation among people.
Even with significant bumps up in cost and clients, the FUSE portion of the entire budget for the Behavioral Health Coordination Department has stayed between a quarter and 30%, said Landreth.
“I think we're starting to get to a point we're figuring out that sweet spot,” she said. “It's a focused cost. The services are billable by Medicaid, so it should be a sustainable model going into the future.”
Metrics precisely measuring benefits to other pieces of the system from services not given are tougher to come by, though Landreth is confident they are significant.
“When it comes to looking at the cost of an emergency department stay, when it comes to looking at the cost of getting admitted for psychiatric care, those are some big bucks,” she said.
And cost per person may not be the best assessment method. Another difficult-to-quantify benefit is for people who, after treatment, reconnect with family members and get a job.
“I think there's a there's a social cost that we're going to be able to see over time by reinvesting in the people in our community that keep on getting stuck in these cycles, so that they can get back out there and participate the way that they want to. I think overall, that's going to really benefit our community,” said Landreth.
“Any of those little victories, if it means that someone still doesn't want to start medications, but they start coming into the office twice a month instead of once a month, all of those little victories make a big difference over time, and it's something that we really enjoy doing, and think that it's worth time, worth the resources,” said Kirstein.
