Health Starts at Home

A cross-sector meeting of the minds

June 1, 2021

In 2021, the argument that one’s housing situation affects one’s health has been too clearly proven by pandemic stats for anyone to demur. For many it has long seemed an intuitive truth, but questions remained: First, can we empirically demonstrate it, and second, what can we do about it, if in ordinary practice health-care providers can’t write a prescription for their patients’ housing. Those questions engendered a five-year pilot program called Health Starts at Home, launched by the Boston Foundation with several partners. With funding provided through planning, implementation and assessment phases, beginning in 2015, four partnerships of health-care and housing/social support organizations were formed, which devised their own interventions to help improve clients’ health and housing stability, and collected data on the outcomes. 

Watch a recording of the webinar

This is all reported in the newly released Health Starts at Home: Final Evaluation Report and summarized in a press release. On June 1, the Foundation hosted a forum in which evaluation researchers presented data, representatives from the Health Starts at Home partnerships talked about their respective approaches and learnings, and a panel of housing and health experts talked about the findings in relation to the daily work of physician, administrator and public servant.   

It was a rich morning of conversation, with overlap and agreement on several points. On the whole, data point to health benefits from more stable housing: Fewer emergency room visits for children, better self-assessments of mental health for caregivers. Some of those benefits were seen even where housing didn’t materially improve, suggesting that the coordinated support services in themselves, simply having a culturally/linguistically comfortable and consistent human connection in case management, was also a powerful boost to well-being, especially regarding mental health. 

As Boston Foundation Associate Vice President, Education to Career and Health & Wellness Elizabeth Pauley said in introducing the discussion she moderated, “Health Starts at Home did not set out to prove housing stability is better than homelessness, but to understand what partnerships and practices can help get us there.” As takeaways on that front, Stefanie Shull of The Neighborhood Developers pointed out, “Integrating social services with medical providers doesn’t happen naturally. We need bridge staff” on the medical system and on the social service sides who understand what the other does, and who “can offer more than a list of resources” and actually help them navigate toward their goals. Dr. Megan Sandel of Children’s Health Watch agreed that “co-navigation” and having an integrated service team was essential: “Patients hate feeling ‘handed off’ and having to repeat the same information to new people all the time.” Candace Lucas of Boston Healthcare for the Homeless added that part of that service needs to include coaching and mentoring to empower families to navigate the systems on their own down the line, and Georgia Katsoulomitis of Massachusetts Law Reform Institute emphasized ongoing, proactive support from service providers, not just swooping in at a crisis point. 

Their advice for other organizations setting up cross-sectoral service organizations were: 

  • Do focus groups before you begin. 
  • Get leadership involved early. 
  • Understand that integrating services is hard work, with a system only as strong as its services themselves.  
  • Keep in view that poverty and racism are traumas that can affect families and individuals every day. 

After the reflections from the Health Starts at Home organizations, Boston Foundation Director of Neighborhoods & Housing Soni Gupta led a conversation among leaders in health and social services who are eager to advance the work. They shared what resonated with them from the report and discussion, and again concordance prevailed. Cooperation and coordination between various agencies and institutions are the way forward. Leslie Aldrich, Executive Director, Center for Community Health at Massachusetts General Hospital, looked back on changes in the last 10 years and how in that time the notion of “social determinants of health” has become widely accepted and that has helped break down some territorial walls: “No one organization can be the hero in this.” 

“Health Starts at Home did not set out to prove housing stability is better than homelessness, but to understand what partnerships and practices can help get us there.” - Elizabeth Pauley

Dr. Snehal Shah, Pediatrics Specialist at Boston Children’s Hospital (among other roles), agreed, noting that health-care organizations have to tackle their mission of patient care through work in all domains: with families and individuals in clinical settings; in community space; and in policy and advocacy. Gloria Meneses, Director of Compliance with the Boston Housing Authority, added the need to educate lawmakers and expand the scope of factors that can holistically impact health, such as transit, child care and insurance.  

And all agreed, as Aldrich put it, “We need to realize that racism is a public health issue. We need to look at systems in our own institutions and lives…. that means listening and learning. If you’re an anchor institution, look at how you hire, how you purchase and invest in the community.” 

Gupta closed the event, acknowledging that the audience held former Boston Foundation staffers who had been integral to the launch of Health Starts at Home, among so many other interested parties, which adds to the strength of the pilot and its assessment data: “We know housing is a human right. We aren’t there yet, but with this work we are all rowing in the same direction.”