Close to home: Integrating primary care in permanent supportive housing

Wednesday, June 1, 2016
Pavilion Ballroom (Hilton Portland)
Richard Waters, MD, MSc (Site Medical Director, Downtown Homeless Programs, Neighborcare Health)
Tricia Madden (Homeless Services Program Manager, Neighborcare Health)
Sandhya Agrawal (Project Manager for Health and Housing, Neighborcare Health)
Janet Cady, MN, ARNP (Associate Chief Medical Officer, Neighborcare Health)
Zoe Reese (Director of Specialty Programs, Operations, Neighborcare Health)
Research has shown the significant impact of supportive housing, using the Housing First model, on health and health care utilization in various subpopulations of people experiencing homelessness. Supportive housing has traditionally included case management with assistance in linking clients to off-site health care resources, rather than including on-site provisions of health care (1,2,3). However, significant barriers to accessing off-site health care for individuals in supportive housing persist, including transportation difficulties, anxieties in accessing new locations, difficulties related to no-show policies, and perceived lower quality of care when services are not tailored to the unique needs and challenges of those with experiences of homelessness. In Seattle, Washington, a community health center within Neighborcare Health noted a 28 percent no-show rate amongst individuals in multiple apartment-based supportive housing sites located just blocks away from the clinic (4). Neighborcare Health already has nurses working in these supportive housing sites through its Health and Housing Outreach Team, who anecdotally note the barriers to clients' presenting for care at nearby but off-site locations, with anxiety rooted in prior traumatic experiences being notable. Modeled on the Los Angeles experience of partnership between Federally Quality Health Centers and permanent supportive housing developers, Neighborcare Health is embarking on a model of integrated primary and behavioral health care within supportive housing, to begin in December 2015 (5). In our poster, we will discuss our experiences in initial planning stages in this model. We will discuss the evolution of our partnerships with local supportive housing developers in pursuing a phased scale-up of the care model. We will describe the quality metrics chosen to evaluate the project, including process metrics that measure the characteristics of primary care itself (particularly accessibility, continuity, and comprehensiveness) as well as outcomes metrics based on the Triple Aim. We will discuss changes in the care model resulting from the advantage of being on-site and the challenges of a single team to maintain the breadth of care. Lastly, we will discuss the value of supportive networks between on-site primary care teams at different housing sites and traditional primary care clinics. In sharing our experiences and lessons learned in these initial phases of the project, we hope to provide insight into the challenges and strategies of implementing an integrated health care in housing model.

1 JAMA 2009; 301:1349.

2 JAMA 2009;301:1771.

3 Am J Public Health 2009;99:S675.

4 Am J Public Health 2013; 103:S331.

5 "Integrating FQHC Health Care Services with Permanent Supportive Housing in Los Angeles," United Homeless Healthcare Partners and CSH, March 2011. Topic areas included: Health care delivery models addressing needs of formerly homeless individuals in supportive housing; quality measures; partnerships between health care organizations and supportive housing organizations.