BY: DAVID WERNING
Catholic Charities USA has started its Healthy Housing Initiative to integrate health and housing services to simultaneously address both chronic homelessness and health care issues related to homelessness. In early 2019, five diocesan Catholic Charities agencies were selected to pilot a five-year, multimillion-dollar initiative. It is beginning in the regions of St. Louis, Detroit, Las Vegas, Portland, Ore., and Spokane, Wash.
The goals are ambitious in the pilot cities. By 2025, Catholic Charities wants to reduce chronic homelessness by 20%; decrease hospital readmission rates for the newly housed by at least 25%; and connect 35% of this population with primary care and behavioral health services. The participating Catholic Charities branches will collaborate with hospitals in their areas, housing developers, government, financial institutions and private funders to work toward these goals.
Curtis Johnson, vice president of housing strategy for Catholic Charities USA, explained, "The Healthy Housing Initiative is really an outgrowth of one particular agency in Spokane (Catholic Charities Eastern Washington) working to solve homelessness and partnering with a local hospital and telling the rest of the membership about it. We learned from them that housing is a social determinant of health and that people who have stable shelter are healthier and use emergency room services less often. The question became how to ‘co-locate' health services and residences in other cities so that homeless people who got ill and who were admitted to a hospital had a shelter to go to for healing instead of back to the streets."
Encouraged by Spokane's example, Catholic Charities USA in 2017 brought together staff from regional Catholic Charities agencies in order to discuss how the Catholic Charities ministry nationwide could address the integration of housing and health care. They considered the existing capacity and infrastructure among their agencies, including investment capital, housing supply, health policies, demographics, affordability and the potential for collaboration with church and government organizations. The results of the meeting showed that the Catholic Charities ministry — which has 167 agencies nationwide — is a unique space where both comprehensive care and safe shelter could be provided at single locations to better address the problem of homelessness in communities.
Building upon the conclusions of the 2017 meeting, Catholic Charities USA requested and received funds from the Kresge Foundation for a "Healthy Housing Innovation Lab," which took place in Chicago in June 2018. The gathering brought together 41 professionals from 16 national/regional organizations (including Providence St. Joseph Health and Trinity Health, both members of CHA) and 12 local Catholic Charities agencies for discussion and planning. A major point of discussion was the tendency in the public policy dynamic in the U.S. to address separately the issues of health and housing. Ramona Ivy, then-vice president of health integration for Catholic Charities USA and an organizer of the lab, said, "The challenge was how to help move the discussion away from seeing housing and health care as separate silos, and Catholic Charities really can add to the conversation since we have operated health and housing programs in a collaborative style for many years."
The group identified three assets of the Catholic Charities ministry to include in their plans that will help reduce homelessness and improve health care: converting surplus church property into affordable healthy housing; partnering with Catholic or other local health systems to provide permanent supportive housing or respite services; and using Catholic Charities case managers for integrated care in service models.
They also decided to develop and implement the following two models: permanent supportive housing and homeless shelter medical respite. The permanent supportive housing model follows the Housing First approach, which prioritizes access to permanent housing for individuals experiencing homelessness. The basic need of safe and stable shelter must be met before other needs like health, employment and/or finances can be addressed. Case managers who have knowledge of available affordable housing facilities help formerly homeless persons find wraparound services such as eviction protection, job placement, links to primary and behavioral health care and other services that vary from market to market.
The homeless shelter medical respite model provides acute and post-acute medical care for homeless individuals who are too frail to recover on the streets, but are not ill enough to be in a hospital. A Catholic Charities agency that follows the medical respite model would partner with a neighboring Catholic hospital to operate temporary housing for recently released patients who need a place to recover fully.
The key to success, according to Johnson, is the collaboration of all community partners: "No one group — whether it's the feds, the states or locals — can do it alone," he said. "If you're putting health and housing together, you have to put local and federal agencies together. You have to bring together social service agencies and housing agencies, like Catholic Charities and their partners, with the hospitals."
Rob McCann, president and chief executive officer of Catholic Charities Eastern Washington in Spokane, agrees with Johnson about the importance of such collaboration. The success his agency has had in serving the homeless population reflects the work of many people and organizations. McCann also notes the importance of leadership when it comes to big ideas like the Healthy Housing Initiative.
Sr. Donna Markham, OP, PhD, president and chief exectuive officer of Catholic Charities USA, considers the Healthy Housing Initiative a prime example of the work and mission of Catholic Charities, which always seeks new ways to approach perennial problems. "Serving people, particularly those who are poor and vulnerable, continues to be the focus of our ministry," Sr. Markham said. "That's why we don't fit people into our programs. We build programs to help people."
DAVID WERNING is director of content development at Catholic Charities USA in Alexandria, Va.
The five Catholic Charities member agencies taking part in the Healthy Housing Initiative are Detroit-based Catholic Charities of Southeast Michigan; Catholic Charities of St. Louis; Las Vegas-based Catholic Charities of Southern Nevada; Catholic Charities of Portland, Ore.; and Spokane-based Catholic Charities Eastern Washington.
A CLOSER LOOK: ST. LOUIS STRIVES FOR HEALTH CARE, HOUSING GAINS
The timing and mission of Catholic Charities USA's Healthy Housing Initiative fits well with work Catholic Charities of St. Louis has already started. Last year, the Most Rev. Robert J. Carlson, Archbishop of St. Louis, took a closer look at the issues of poverty and health care in the archdiocese, which includes the city of St. Louis and 10 area counties. To better address these issues, the archbishop charged Catholic Charities of St. Louis with developing a mobile clinic in order to bring health care and social services to the uninsured in some of the poorest counties of the archdiocese. The clinic, staffed by both paid and volunteer health professionals, began treating patients in May at St. Joachim Parish in eastern Missouri. Carlson said access to good health care is a basic requirement for all. "Participation in the Catholic Charities Healthy Housing Initiative is a wonderful extension of our recent efforts, in this case focusing on the more densely populated St. Louis area."
Prior to the announcement that Catholic Charities of St. Louis had been selected for the Healthy Housing Initiative, a St. Louis-based community organization working to reduce homelessness, St. Patrick Center, had already studied several successful health and housing models. In 2018, St. Patrick Center — one of Catholic Charities of St. Louis' eight federated agencies — reached out to Barnes-Jewish Hospital and its parent organization BJC HealthCare, and the Behavioral Health Network of Greater St. Louis, a coordinated system of behavioral health care in eastern Missouri. St. Patrick Center sought collaboration to help develop Hospital to Housing, a community partnership pilot program that closely mirrors the goals of Catholic Charities USA's larger initiative.
"Catholic Charities USA's Healthy Housing Initiative is a perfect complement to our existing work, as well as the work other Catholic Charities of St. Louis agencies do in the areas of housing and health," said St. Patrick Center Chief Executive Laurie Phillips. "We hope that this collaboration with Catholic Charities USA empowers us to make even more sustained, positive change in our community."
Health care is an important addition to the wraparound services that St. Patrick Center provides, and it is currently identifying partners to help connect clients to health care. From May 2019 to May 2021, Hospital to Housing will identify 20 chronically homeless individuals who are emergency department high utilizers. These individuals will be referred to the Hospital to Housing program. Each patient will participate in a discovery session with a St. Patrick Center intake specialist. Patients who engage by expressing interest in the program and a willingness to commit to it will be enrolled in the Hospital to Housing program and provided permanent housing options, as well as intensive case management services. Those services include rental and utility assistance; physical and behavioral health support; employment training and placement; increased income through benefits or earned income; access to transportation and more.
Once all 20 openings in the Hospital to Housing program are filled, the program will close for new intakes until someone in the program disengages, by saying they don't want to continue to participate, or by failing to meet program requirements. Through May 2021, St. Patrick Center will provide case management and rental assistance to these 20 clients.
The specific program goals are to:
- Provide a permanent, sustained housing solution for people who are chronically homeless.
- Connect clients with needed services to maintain their permanent housing.
- Provide clients with physical and behavioral support services outside of the emergency department, when possible.
- Improve physical and behavioral health outcomes of these clients.
- Use community resources for improved care.
"Hospital to Housing will allow us to reduce chronic homelessness in the St. Louis region by expanding our network to provide more affordable housing and health care options for our clients. It's a win-win-win for hospitals, service providers and people who are chronically homeless," said Phillips.
While St. Patrick Center is taking a leadership role in the St. Louis Hospital to Housing program, partners in addition to BJC and the Archdiocese of St. Louis include the Incarnate Word Foundation, a ministry of the Sisters of Charity of the Incarnate Word; two Catholic health care systems, Mercy and SSM Health; and other organizations in the Catholic Charities of St. Louis federation of eight agencies in the archdiocese.
Theresa Ruzicka, Catholic Charities of St. Louis president, said she is proud of the work the agencies do to help empower people who are poor and vulnerable. "This opportunity from Catholic Charities USA is a blessing that I hope will help us further expand our ministry to people who are experiencing home insecurity, health care deficits and other barriers to independence. We are fortunate to have so many excellent health care systems in St. Louis and we appreciate their willingness to collaborate with us, combining our areas of expertise to improve the health and lives of those most in need."
LISA SHEA is marketing and communications manager for Catholic Charities of St. Louis.
What Is Housing First?
St. Patrick Center has long used the Housing First model, as is required for participation in Catholic Charities USA's Healthy Housing Initiative.
Housing First is an evidence-based practice that prioritizes placing people in safe, stable, permanent housing before addressing their additional needs like health, education and employment.
St. Patrick Center is the lead agency for Coordinated Entry, a multi-agency St. Louis metro area Housing First effort. Coordinated Entry intake specialists at St. Patrick Center conduct sessions with clients, in order to discover their needs. They help clients secure housing — the center both owns housing and works with area landlords — and helps to provide the correct level of support services before, during and after clients are housed.