Q&A: Building Changes’ health learnings so far

Published: August 29, 2023

Exploring why integrating health care into housing support is so important, and what that means for Building Changes’ work.

Healthy communities and stable housing are inextricably linked. For young people and families experiencing homelessness, receiving health services alongside housing support can make a significant difference in people’s wellbeing and whether they are able to obtain and sustain housing. That is what Miranda Vargas learned from her own professional experience and research on how organizations throughout Washington integrate health care into housing support services.

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Miranda Vargas

Miranda Vargas is the senior health strategy specialist at Building Changes. She has extensive experience working directly with people who are experiencing homelessness and housing crises. Through a grant with Kaiser Permanente, Miranda was able to create a fuller picture of what it means to address health service gaps for youth and families experiencing homelessness throughout Washington. “At Building Changes, we want to help un-silo resources and one of the ways to do that is by looking into housing and health services and how they can be more integrated,” she said.

Although there are organizations that have integrated health care into housing support services, health systems and housing systems often operate separately. This creates incongruent support for people experiencing homelessness. By learning how Diversion can be incorporated into support services, or how various health-housing integration support strategies have already successfully served communities, Miranda hopes to push forward solutions that that will improve the lives of youth and families throughout Washington. She shares with us some of her key learnings from her research and her goals to move forward Building Changes’ health work.

What health issues do youth and young adults experiencing homelessness face? Why is it important that health services are integrated in housing support for youth and young adults?

Some of the most ubiquitous health challenges that I heard regarding youth and young adults were behavioral and mental health issues. We know that a higher proportion of homeless youth and young adults are people of color who are also part of the LGBTQ+ community. Part of the challenges that they face are behavioral and mental health issues that come with a lack of gender affirming care, not having access to that, and not having providers who are competent to work with youth who are homeless and can treat them with the respect and care that they need. This contributes to mental health challenges, including increased suicidal rates. That is what I found in my health landscape and listening session learnings. It was heard across the board in all counties from every group that was working with youth.

Another issue minors face is Medicaid eligibility. It is such a blackhole of information for so many people, let alone for minors or young adults who have very little to no experience interacting with Medicaid. They’re kind of flying blind in a sense when they’re going out into the community trying to figure out where they can get services and who is going to be equipped to serve them.

When services can be integrated with housing support services, where the providers are very competent and familiar with the people they’re working with, needs can be met in vastly different ways.

And how about for families? What specific issues do families face? Why is it important that health services are integrated with housing support?

One thing that I really heard across the board was the importance of respite care for parents and children. We know that Black mothers experience a mortality rate three times the rate of white mothers, and most deaths occur postpartum. They happen within the first year after giving birth. Having a place for respite, where new mothers, or birthing parents, can come to rest and heal can impact both the mother and their child’s health moving forward. Especially if they’ve had complications during birth, which Black mothers experience at a disproportionate rate compared to white mothers, having respite care allows them to bond with their child and not have to worry so much about surviving in those first weeks and months of their child’s life.

Similarly, when children are treated for health issues like cancer or other chronic illnesses, a lot of times, health professionals in hospitals also aren’t asking questions about where they’re going to go after they receive care. That is why Diversion should also be included in health care to make sure children and families are housed. When health professionals are integrated in housing support services, they can make sure that their patients are set up to stay in a permanent place or semi-permanent place rather than going onto the street or living in their cars. Having integrated Diversion strategies incorporated into hospital discharge plans can make sure patients are being set up for a healthier life.

What is Diversion and how does that work in integrated health care in housing support services?

Diversion is an approach where health and housing providers have creative conversations with people experiencing homelessness or at risk of homelessness, so that people can come up with their own solutions to find housing. Diversion helps providers figure out what kind of support clients need. Each family, youth, or young adult has different needs, and so they may require different types of referrals and supports.

What are the different types of health care services you saw being integrated into housing support from your learnings?

I saw examples of embedded health care, whether it was medical, behavioral health or mental health on site in housing support. Health care may include counselors, primary care physicians, someone dedicated to health navigation—they’re helping folks sign up for health insurance or arrange health care services, referring people to health or housing services, and helping to figure out transportation to receive health services.

There are also many organizations that do mobile health care. A clinic team might drive around in their van once a week, making stops at various housing sites to provide either acute care or primary care for kids and their families. This was something I heard that happened a lot during the pandemic. Some health organizations do home-based visits, which if we’re talking about folks in housing crisis, could include where they are staying, such as someone else’s residence, a shelter, or a safe location.

There are also a few examples of housing sites that have dedicated respite care programs where parents who have just given birth can spend some time with their infants post-partum and have that time to heal and bond. For kids who might have had a long hospital stay due to a chronic illness or surgery, who don’t have a place to go, these respite care programs can provide a safe space to heal.

Are there any methods that are more successful than the other?

I think they’re all successful in their own ways since each one of these strategies is needed by so many people. There is no one cookie-cutter solution for every community. The folks running these programs know who their clients are and know what their clients need. They’re going to tailor their integrated services to their populations and to their communities. In general, when health services exist where people are living or staying, it takes away a lot of the barriers that they have to receive care, especially in places where the integrated health staff have specialized knowledge and skills working with people with who are in a housing crisis. I think that goes a long way in terms of meeting the emotional and holistic needs of people.

What folks in urban areas need might be different from what folks in rural areas need. The number of resources that exist in urban versus rural is going to be different, the accessibility of resources is going to be different, and those populations in housing crisis might be different. Being able to tailor those approaches to the populations is what makes these strategies successful regardless of what the actual strategy is.

Do you think that homelessness and health can ever be separated?

We know that having a health crisis is one of the top reasons that people may experience homelessness or a housing crisis in the first place. In previous work that I’ve done working directly with people, they described that the stress of homelessness takes a great toll on your body, your mind, and your soul—all things that impact your health and all things that can make it harder to follow through on services or accessing services that might help people leave homelessness.

I’ve also heard many stories of housing workers who are just not equipped to deal with the heavy mental and physical health challenges of their residents. We can house folks, but if housing providers are also dealing with people’s serious health issues, staff might not have the support they need to adequately provide health support for the people that they’re trying to serve. This can result in people potentially losing their housing, not getting the health services they need, and even early death. If there were health or medical staff on site that were integrated in housing support, it would be just another part of resident’s living experience to get the holistic support they need in housing and health.

How do you want to use your learning to expand on Building Changes’ health work?

I really want my findings to direct future work, whether that is creating more convening space, whether it is advocating at a policy level. I want the evolution of this work to integrate health care into housing to be rooted in communities. How can we as a community, and that includes Building Changes, funders, community organizations, government, the communities themselves, continue to strategize and expand on this work. The current health and housing system is often siloed, including the way funders’ grants are created. I would also like this information to be used to advocate for the prioritization of health and housing integration work to funders.

If we integrate health care into housing support services, we can improve the chances of folks attaining and sustaining long-term housing. This could also prevent those experiencing housing instability from losing their housing at all, particularly for youth. When you support youth and young adults in improving their health situations or their housing situations, it can help them stay in school, help them achieve employment successes, or just any goals that they have for themselves. It can change the trajectory of their lives.

For families, especially in terms of maternal health, my hope is that we could reduce the deaths and complications of Black and Brown mothers during and after giving birth. Providing integrated health and housing support, including respite care, and being able to support the family as a whole is so important.

To learn more, watch Miranda’s webinar, Landscape of Health & Housing Services Integration in Washington State, where she shares findings from her statewide research and discusses efforts to integrate health and housing services for youth and families experiencing homelessness.

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