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Health Starts at Home

Health Starts at Home

Over the last decade, researchers have found that instability in housing, driven in large part by unaffordable rents, has a profoundly negatively impact on a child’s mental, behavioral and physical health. The result is higher health-care costs and increased burdens on homeless systems and providers.

Health Starts at Home is an initiative hosted by the Boston Foundation that brings together housing and health-care organizations to support work that demonstrates the positive benefits of stable, affordable housing on children’s health outcomes. This four-year initiative supports partnerships among housing and health-care organizations with the goal of:

  • highlighting the importance of affordable housing in children’s health outcomes;
  • identifying promising new and existing models that can be brought to scale to improve children’s health outcomes;
  • decreasing health care costs; and
  • decreasing costs related to homelessness.

PHASE I: Planning Grant Competition

In 2014, the Boston Foundation received 12 applications representing collaborations among more than 50 organizations. Following rigorous review by a 10-person panel of both internal and external reviewers, four nine-month planning grants of $40,000 were awarded. During this planning period, in addition to refining their interventions, each partnership worked with the evaluation consultants, Health Resources in Action and the Urban Institute, to develop shared measures and data collection protocols for the evaluation of housing and health outcomes.

PHASE II: Implementation

Upon completion of the nine-month planning phase, proposals were submitted for implementation funding that included details about refined program models, outcomes and partnership roles. Following a second panel review, four partnerships were awarded three years of support totaling $200,000/year to implement their program models and evaluation plans. The partnerships supported with Phase II implementation grants are highlighted below.

BUILDING BRIDGES TO BETTER HEALTH

Partners: Boston Health Care for the Homeless Program, Urban Edge, St. Mary’s Center for Women and Children

Model: Housing instability is a precursor to poor health, too often causing families to receive fragmented health care and to use costly emergency services when symptoms escalate into health crises. In addition to the stress of homelessness, families experiencing homelessness are isolated from their home communities, as well as sources of health care, employment and education; endure crowded living conditions; and lack important resources such as cooking facilities, transportation and healthy food. To address the health disparities that homeless children experience, this partnership—uniting the respective expertise of Boston Health Care for the Homeless Program, St. Mary’s Center for Women and Children and Urban Edge—will develop a model of coordinated and integrated services designed to improve access to comprehensive health care, behavioral health services, social supports, benefits screenings and housing search services. This new model will assure access to integrated services while families are in shelter, and will follow families as they transition into housing to support them during this tenuous time and prevent the financial, social and health crises that too often result in a return to homelessness.

CHELSEA HEALTH STARTS AT HOME

Partners: The Neighborhood Developers, Massachusetts General Hospital (MGH) and MGH Chelsea HealthCare Center, Metropolitan Boston Housing Partnership, Roca

Model: This partnership includes major institutions in Chelsea, a mid-size city just north of Boston with a largely immigrant population, where 50 percent of residents cannot afford stable un-subsidized housing. MGH Chelsea, the health-care provider serving the majority of households in the community, and Roca’s program for high-risk young mothers will screen families for housing instability as a part of their regular course of care. The screening will provide partners with the knowledge and capacity to refer families to existing, robust services at CONNECT, a collaboration housed at The Neighborhood Developers, including access to short-term rental assistance and long-term stabilization supports, including benefits screening, financial coaching and services, workforce development resources, housing counseling and peer supports.

HOUSING PRESCRIPTIONS AS HEALTH CARE

Partners: Children’s HealthWatch, Project Hope, Boston Housing Authority, Medical-Legal Partnership, Nuestra Comunidad, Boston Medical Center – Problem Solving Education, BMC HealthNet Plan

Model: This partnership will create a seamless system of services for children under the age of four whose families are high users of emergency health care services. Medical staff often does not ask about a family’s housing situation because they cannot offer “treatment.”  This model will build on the existing Children’s HealthWatch interview protocol, enabling trained interviewers to ask validated questions and link families to care coordination services at Project Hope. Intensive case management will help families find, retain and improve their housing by linking services of benefits maximization, legal services, problem solving education and priority access to public housing units.

MORTAR BETWEEN THE BRICKS: BUILDING A ONE STOP, TWO-GENERATION FOUNDATION FOR HEALTH

Partners: Massachusetts Law Reform Institute, Boston Children’s Primary Care at Martha Eliot Health Center and Longwood, Horizons for Homeless Children

Model: This partnership includes a nationally recognized medical provider, poverty law experts focused on policy reform and early childhood development specialists. Together, they will identify patients of Boston Children’s Primary Care at Martha Eliot Health Center and Longwood who are at-risk, housing insecure and homeless using a new universal housing screen. Dedicated social work staff at Boston Children’s Primary Care at Martha Eliot Health Center and Longwood will coordinate interventions to stabilize families, including intensive legal services, housing workshops, parent trainings, early education and childhood development programs and referrals to other social services. Through an integrated cross-referral system, this model intentionally focuses on services to the adults as well as to the children, based on a two-generation framework informed by an advisory committee that includes patient parents.

Learning and Evaluation

Each of these partnerships work with Health Starts at Home’s evaluation consultants, Health Resources in Action and the Urban Institute, to assess program effectiveness through a set of shared measures related to housing stability and children’s health. In addition, these partnerships receive technical assistance and participate in a learning community to continually enhance their programs. The Health Starts at Home Initiative will also undergo a process evaluation to document successes and challenges, which will inform the Boston Foundation’s future work, as well as the work of others in the health and housing fields.

SUPPORT

We wish to thank our funding partners in this initiative: The Kresge Foundation, John D. and Catherine T. MacArthur Foundation, Blue Cross Blue Shield of MA Foundation, Partners HealthCare, and Annie E. Casey Foundation for their partnership in this work.

Join the Boston Foundation in supporting the implementation of promising projects developed through Health Starts at Home. Learn more about Health Starts at Home by contacting Mira Kahn, Program Associate, at 617-338-4093. To explore making a gift or grant to this initiative, please contact Laura McConaghy, Philanthropic Partnerships Officer, at 617.338.1612.