Developing a holistic approach to homelessness

AS WINTER MARKS the return of frigid temperatures and with COVID-19 cases on the rise, the challenges ahead for people experiencing homelessness are truly alarming. Overcrowded shelters and growing encampments foster the spread of illness and limit effective health interventions. The pandemic has brought into sharper focus the fact that homelessness is a public health crisis – and made it clear that it has never been more important to link permanent housing with healthcare and other forms of support.

Without the stability of housing paired with essential services, those experiencing homelessness cycle in and out of shelters, correctional facilities, and hospitals – a practice that is inefficient, costly, and, most importantly, impedes improvements in health for those who have multiple chronic conditions that are exacerbated by their homelessness. As the pandemic continues to strain the service delivery system, it is critical that we put forward a holistic, coordinated approach in order to best meet the needs of this vulnerable population.

Research confirms what we have long believed: securing permanent housing is the first important step in ending homelessness for adults with complex needs. The next step is connecting these individuals with essential services. That’s why the role of community health workers is so critical. Community health workers – non-clinical professionals trained in health advocacy – help people transition to housing while also coordinating key services. The role of community health workers is not only crucial to homeless individuals’ long-term success; it’s proven to be cost-effective.

Hospital to Housing – the three-year pilot program that the Massachusetts Housing & Shelter Alliance and the Massachusetts Behavioral Health Partnership/Beacon Health Options (MBHP/Beacon) pioneered in Boston, Lowell, and Pittsfield – demonstrates the lasting benefits of the community health worker model. Through this innovative initiative, community health workers offer client-centered support and much-needed guidance in real time, helping high-risk individuals access primary and behavioral health services, transportation, nutritious food, and, most importantly, permanent supportive housing. Community health workers help clients identify available resources and navigate the “alphabet soup” of state and social service agencies that offer all-important resources.

Many marginalized adults lack emotional support and suffer from severe trauma. For the vast majority of their clients, community health workers represent their only sustained, caring human relationship and a lifeline to a host of services. These frontline workers – acting as allies, advocates, and intermediaries – engage with clients one-on-one, forming trusting relationships that improve overall well-being. Across the board, we find that the Hospital to Housing model increases participants’ use of flexible, community-based outpatient services (a 23 percent increase, according to one study) while decreasing the need for intensive 24-hour behavioral healthcare.

By creating stable relationships that allow individuals to reduce their dependence on emergency services, the Hospital to Housing model offers a path forward for individuals who might otherwise continue cycling in and out of the system, and it ensures a more responsible use of treatment dollars.  Without question, this comprehensive approach should be replicated across the Commonwealth.

Safe, supportive housing is essential in improving health and wellness for adults experiencing chronic homelessness. But housing alone is not enough. For this vulnerable population to thrive, regular access to vital services is required. An investment in programs like Hospital to Housing can help eliminate reliance on temporary, high-cost fixes and change lives in ways that are meaningful, measurable, and long-lasting here and across the country.

Joe Finn is the president and executive director of Massachusetts Housing & Shelter Alliance and Carol Kress is vice president for client partnerships at the Massachusetts Behavioral Health Partnership.