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Social determinants of health are garnering increased attention, especially as research continues to show just how much unmet social needs significantly affect our health. It is often said that zip code is more important than genetic code in determining overall health and wellness.
Arguably, nowhere is this more true than for people experiencing chronic homelessness. How can anyone be well if the most basic life fundamental isn’t being met: a stable roof over one’s head? It’s for this reason that Beacon Health Options’ Massachusetts Behavioral Health Partnership (MBHP) and the Massachusetts Housing and Shelter Alliance (MHSA) started the Hospital to Housing program.
Launched in 2016, Hospital to Housing helps chronically homeless people – specifically those who frequently use inpatient behavioral health care – access permanent supportive housing, primary and behavioral health care, and other community-based services, with the ultimate goal of improving their health. Results from a recent outcome study show promise that the program is indeed improving health and wellbeing.
Program nuts and bolts
Collaborating with MHSA, MBHP hired and trained five community health workers (CHWs) experienced in serving homeless individuals and assigned them to shelters and inpatient units in key Massachusetts communities. The CHWs meet eligible individuals wherever they happen to be – in the hospital, on the streets, or in shelters – and help them access housing and community-based services.
Specifically, the CHWs help program participants complete housing applications, address transportation challenges, solve criminal record issues that can hamper access to housing, and more.
The study and its results
To measure a participant’s health outcomes, the study reviewed claims data to discern any changes in the pattern of services one year before and one year after program enrollment. A shift in cost patterns during this period that reflects decreased use of intensive 24-hour care – while increasing the use of outpatient services – indicates individuals’ health is improving, as they no longer need the more intensive services.
MBHP compared the costs of services used by two groups of individuals with a history of homelessness and mental illness: the first group was 20 continuously enrolled Hospital to Housing program participants, and the second group included 45 individuals not enrolled in the program. The results were as follows:
1. Usage of 24-hour levels of care, including psychiatric inpatient hospitalizations and substance use disorder withdrawal management
- A 54 percent decrease for the program-enrolled individuals
- A 2 percent decrease for the comparison group
2. Usage of outpatient levels of care
- A 23 percent increase by the program participants
- A 43 percent decrease by the comparison group
However, it’s more than data that supports the program’s value. Its value also lies in the words of the people served by the program. Says one participant:
“[Working with my CHW] actually makes me not so stressed out. . . Because I know there is somebody who I could call anytime I needed to, to help me. And before her, I had nobody to call.”
The study’s results support the view that something as basic as housing can improve a person’s wellbeing. The US spends approximately $3.5 trillion a year on healthcare but spends a relatively small share of its economy on social services that provide citizens with basic resources, such as stable housing, nutritious food, and transportation to doctors’ appointments. Further, Americans have the lowest life expectancy and more chronic health conditions among comparable countries, including Japan, Switzerland, Sweden, Germany and more.
Such data provides food for thought. Where do Americans want to spend their hard-earned dollars to improve their health and wellbeing? If the ultimate view is to shift to a model that pays closer attention to social determinants of health, the behavioral health industry – with its many touchpoints across the healthcare and social services continuum – is well poised to take the lead in changing that dynamic.