We know that as the energy in the health care world turns to reinventing health care delivery systems, social and economic determinants of health and the role they play in community health are front and center. Studies have uniformly shown that social, economic, environmental and behavioral factors play a larger role in determining health than genetics and health care combined (as illustrated by the County Health Rankings and Roadmaps program infographic below).  /></p> <p>However, we know that addressing any of the social and economic determinants of health requires robust partnerships between health care systems and providers, as well as numerous others in the community, many of whom may have never worked together in a formal way. The intersection between health and human services and housing is well-documented by the Kresge Foundation and Policy Link in their <a href=Healthy Communities of Opportunity: An Equity Blueprint to Address America’s Housing Challenges.

Over the past year, I had the opportunity to contribute to one such effort here in Boston related to the intersection of health and housing. These initiatives offer some good insights into how these partnerships might work to support vulnerable families accessing the health care system to gain access to secure, safe and affordable housing that is essential to their overall health.

The Boston Foundation (TBF), in collaboration with the Kresge Foundation, the John D. and Catherine D. MacArthur Foundation, the Blue Cross Blue Shield of Massachusetts Foundation, and Partners HealthCare, is funding opportunities to create and sustain health and housing partnerships in greater Boston. This program, the Health Starts at Home initiative, seeks to improve health outcomes for children and their families by ensuring families’ housing needs are addressed in conjunction with their health and other social service needs. Each project is approaching the intersection of health and housing differently, each with a variety of partners, including hospital/health centers, social services agencies, housing providers, legal services, and/or homeless programs.

As diverse partners come together, there is incredible synergy and opportunity—yet there are challenges and important lessons for others as they plan and collaborate to address safe, secure, affordable housing as one of the individual needs necessary to maintain and/or improve health for children and families.

Tracking Families Is at the Center of the Work.

When working with three different agencies in three different, yet connected, domains, tracking families is vital. The families in the Health Starts at Home program are housing insecure – they may be in and out of shelter, placed in shelters far outside the Boston area, and/or difficult to contact. Combine that with the variety of challenges they face—from food insecurity to employment volatility—and the number of agencies providing services, and you have a difficult time getting a clear picture of where they are in the housing process.

Establishing a workflow and a tracking process means families receive robust services, everyone is on the same page, and families don’t slip through the cracks or get lost in the process. This is a complex undertaking.

All Partners Have a Role.

In each of these projects, there are a diverse set of partners, each with a distinctive role as it relates to health and housing. For example, the hospital can conduct assessments and make referrals for needs, including housing, through a coordinated case management program. Legal services can provide legal representation to housing-insecure families, or provide education to families living in homeless shelters. Homeless shelters can help families navigate early education and child care subsidies as well as host training and educational programs that help residents understand the resources available to them. While everyone has a role, those roles overlap and intersect, demanding a high level of communication among partners and a shared mission and set of values.

Understand Capacity and Bandwidth.

An unfortunate reality of partnerships is that many organizations lack staff capacity and resources—especially social service agencies, as outlined in a recent article in Health Affairs. Collaboration among agencies, like that in the Health Starts at Home Initiative, can result in greater efficiencies. However, there are several challenges to forming strong partnerships across agencies such as finding a regular time to meet, identifying roles within the group and how they fit into the culture of the agencies. Cultural shifts require commitment and leadership to improve how different partners work together across health and human services to support consumers.

How Do You Know it Worked?

The Boston Foundation, in partnership with Health Resources in Action (HRiA) and outside evaluators, established an evaluation process to measure the efficacy of the proposed interventions. An additional $200,000 in funds is dedicated annually to evaluate the partnerships and the work the organizations are doing together, with the goal of understanding what works and share that with others who want to try these kinds of collaborations.

These are challenging yet important conversations. Advocates are increasingly engaged in discussions about how to move the needle on population health; they have a valuable contribution to make as health and human services stakeholders and decision makers design and implement pilots and initiatives that attempt to embed deeper connections across social determinants and health outcomes. Vehicles for this work span the full continuum of care from screening to treatment to maintenance as evidenced in forward thinking accountable care communities. We look forward to supporting advocates in these ongoing conversations with new partners.

Stay tuned for another blog about the development of a key position in this new work aligning health and housing —the community health worker.

Katherine Fukumoto
Intern with the Community Catalyst Alliance for Children’s Health

Recently, Community Catalyst hosted a national learning community webinar called Health and Housing 101: Understanding the Intersections.  We will be continuing this webinar series in the coming months with additional webinars and calls featuring national, state and local partners who are engaging in work to address health and housing issues. To be included in future emails to learn more about this work, please contact Michele Craig.