Integrating Health and Housing to Address the Needs of Vulnerable Populations

This proposed session is intended to highlight challenges and opportunities in aligning health and housing resources in order to expand permanent supportive housing for vulnerable, high cost homeless populations. The session... [ view full abstract ]

This proposed session is intended to highlight challenges and opportunities in aligning health and housing resources in order to expand permanent supportive housing for vulnerable, high cost homeless populations. The session will include a review of recent JSI research on elements of effective cross-sector initiatives and detailed presentation of San Francisco’s efforts. A set of discussion questions will be posed throughout to stimulate interactive audience participation.

Treating immediate health crises for homeless individuals without addressing underlying issues amounts to a “band-aid” approach that virtually guarantees a cycle of expensive clinical utilization. Estimates of the annual public sector costs of an “average” high-utilizing homeless individual are as high as $150,000 depending on population criteria and methodology (e.g., are criminal justice or costs to libraries of adding extra staff to respond to the needs of homeless individuals included?). Growing awareness of those costs; broader recognition of the impact of social determinants of health on patterns of illness, injury, and health expenditures; expanded Medicaid coverage through the Affordable Care Act; and policy and regulatory changes have resulted in a robust interest in better integration between health and housing.

Permanent supportive housing —rental housing paired with intensive case management services and provided in alignment with the principles of Housing First —has an unparalleled evidence base for improved health outcomes and reduced utilization of health care and other systems. The housing and health sectors share many high-level aspirations for the individuals they serve, yet have separate funding streams, professional training, and departmental authorities, leading to virtual silos even when activities are focused on the same geography and population. There is an emerging body of innovative practice on how to blend funding, engage leadership, share data, and integrate services. We will share conceptual, policy, and practical approaches that are being used to spur innovative initiatives.